University of Maryland

PHR System Resources
PHR Home System Information Training & Training Materials Payroll & Personnel Resources PHR WOW Reports
Where Do I Send Payroll/Human Resources Paper Forms?
Benefits Forms
Form Name Receiving Department Campus Address Contact Name Contact Phone Number
Benefits-Change of Address College Park Benefits Office 1101 Chesapeake Building Janice Smith 301-405-5654
COBRA/LWOP/Contractual/Part-Time Health Insurance Worksheet College Park Benefits Office 1101 Chesapeake Building Janice Smith 301-405-5654
Proof of Birth (Copy) College Park Benefits Office 1101 Chesapeake Building Janice Smith 301-405-5654
Employee Health Insurance Forms College Park Benefits Office 1101 Chesapeake Building Janice Smith 301-405-5654
Employee Retirement Forms College Park Benefits Office 1101 Chesapeake Building Janice Smith 301-405-5654
Tuition Remission Form College Park Benefits Office 1101 Chesapeake Building Kindra Hemphill 301-405-5659
UNUM Life Insurance Form College Park Benefits Office 1101 Chesapeake Building Janice Smith 301-405-5654
UNUM Long-Term Disability College Park Benefits Office 1101 Chesapeake Building Janice Smith 301-405-5654
Data Services Forms
Form Name Receiving Department Campus Address Contact Name Contact Phone Number
Advanced Sick Leave Request PHR Service Center 1101 Chesapeake Building Sherry Costello 301-405-5683
Extended Sick Leave Request PHR Service Center 1101 Chesapeake Building Sherry Costello 301-405-5683
FMLA Unpaid Family and Medical Leave Act Request Staff Relations 1101 Chesapeake Building Tiffany Pittman 301-405-5001
Leave Without Pay Request University Benefits Office 1101 Chesapeake Building Cindy Clifford 301-405-5654
Mailing Label and Roster Form PHR Customer Service Center 1100 Chesapeake Building Candice High 301-405-5674
Employment Forms
Form Name Receiving Department Campus Address Contact Name Contact Phone Number
Application for Employment College Park Employment Office 1104 Chesapeake Building Norma Modeste 301-405-5679
Contingent Agreement/Contract (CII employees only) College Park Employment Office 1104 Chesapeake Building Ellen Marth 301-405-6536
Probationary Employment Report College Park Employment Office 1104 Chesapeake Building Tiffany Pittman 301-405-0001
Position Description Form College Park Employment Office 1104 Chesapeake Building Ellen Marth 301-405-6536
Requisition for List of Eligibles College Park Employment Office 1104 Chesapeake Building Norma Modeste 301-405-5679
Student Wage Exception Form College Park Employment Office 1104 Chesapeake Building Shirley Ross 301-405-5662
Payroll Forms
Form Name Receiving Department Campus Address Contact Name Contact Phone Number
Change of Address Form (in addition to PHR Change) College Park Payroll Services Office 1101L Chesapeake Building Payroll Services 301-405-5665
Direct Deposit Authorization Form College Park Payroll Services Office 1101L Chesapeake Building Payroll Services 301-405-5665
Work Permit College Park Payroll Services Office 1101L Chesapeake Building Ann Anonsen 301-405-5670
W4 College Park Payroll Services Office 1101L Chesapeake Building Payroll Services 301-405-5665
Payroll (Non-Resident Alien)Forms
Form Name Receiving Department Campus Address Contact Name Contact Phone Number
Affidavit of Compliance College Park Payroll Services Office 1101L Chesapeake Building Joan Hoffman 301-405-7477
Citizenship Status Form College Park Payroll Services Office 1101L Chesapeake Building Joan Hoffman 301-405-7477
I-9 for individuals that live and work outside the US College Park Payroll Services Office 1101L Chesapeake Building Joan Hoffman 301-405-7477
I-94 (copy) College Park Payroll Services Office 1101L Chesapeake Building Joan Hoffman 301-405-7477
Information Form for individuals that perform services outside the US College Park Payroll Services Office 1101L Chesapeake Building Joan Hoffman 301-405-7477
NRA I/C Payment Form College Park Payroll Services Office 1101L Chesapeake Building Joan Hoffman 301-405-7477
Rep. Letter College Park Payroll Services Office 1101L Chesapeake Building Joan Hoffman 301-405-7477
SSN/ITIN Card (copy) College Park Payroll Services Office 1101L Chesapeake Building Joan Hoffman 301-405-7477
Visa Document (copy) College Park Payroll Services Office 1101L Chesapeake Building Joan Hoffman 301-405-7477
W-7 Form College Park Payroll Services Office 1101L Chesapeake Building Joan Hoffman 301-405-7477
W-8 BEN College Park Payroll Services Office 1101L Chesapeake Building Joan Hoffman 301-405-7477
W-9 College Park Payroll Services Office 1101L Chesapeake Building Joan Hoffman 301-405-7477
8233 College Park Payroll Services Office 1101L Chesapeake Building Joan Hoffman 301-405-7477