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RMP-3, Forms Management Guidelines Appendix B - Forms Available Through the Planned Purchasing ProgramSeptember 15, 1986
APPENDIX B
FORMS AVAILABLE THROUGH THE PLANNED PURCHASING PROGRAM
A. Centrally Controlled Forms (Mandatory Participation) These forms must
be purchased through the Planned Purchasing Program.
Form Number Form Name
1042S Foreign Person's US Source Income Subject to Withholding
1099MISC Statement for Recipients of Miscellaneous Income
1099R Information Returns
I-9 Employment Eligibility Verification
U5 Check Request (Non-Payroll)
U5-1 Check Request (Non-Payroll) - Berkeley
U5-lE Entertainment Check Request - Berkeley
U5-2 Check Request (Non-Payroll) - San Francisco
U5-4 Check Request (Non-Payroll) - Los Angeles
U5-6 Check Request (Non-Payroll) - San Diego
U5-8 Check Request (Non-Payroll) - Santa Barbara
U5-9 Check Request (Non-Payroll) - Irvine
U85 Travel Expense Voucher
U85-2 Travel Expense Voucher - San Francisco
U85-6 Travel Expense Voucher - San Diego
U85-9 Travel Expense Voucher - Irvine
U196 Application for Travel Expenses
U1414 Vendor Check (Unique to each campus)
U1501 Biography for Academic Personnel
U1638 Statement of Retirement Plan Contributions
U5415 Payroll Check (Unique to each campus)
U5602 Unemployment Insurance Termination Report
U5605 Affirmative Action Data Transmittal
U5637C Tax Deferred 403(b) Plan - Salary Reduction Agreement
U5637CA Defined Contribution Plan-After-Tax Account Payroll
Deduction Agreement
U5637T Defined Contribution Plan and Tax-Deferred 403(b)
Plan-Transfer Request
UBEN100A Annuitant Medical Plan-Continuation/Enrollment/Change/Cancel
UBEN100B Annuitant Dental and Legal Plans-Continuation/Enrollment/
Change/Cancel
UBEN102 COBRA Continuation Election/Open Enrollment
UBEN103 Defined Contribution Plan and Tax Deferred 403(b) Plan -
Roll-over Request
UBEN104 UCRP- Application for Retirement Income
UBEN105 UCRP Election of Retirement Income
UBEN106A Tax-Withholding Election for UCRS Periodic Payments
UBEN106B Tax-Withholding Election for UCRS Nonperiodic Payment
UBEN107 Defined Contribution Plan and Tax-Deferred 403(b) Plan -
Application for Annuity Income
UBEN108 Defined Contribution Plan and Tax-Deferred 403(b) Plan -
Election of Annuity Income
UBEN110 UCRP-Disposition of Accumulations Upon or After A Break in
Service
UBEN111A Tax Deferred 403(b) Plan-Disposition of Accumulations Upon
or After a Break in Service
UBEN111B Defined Contribution Plan-After-Tax Account and Tax-Deferred
403(b) Plan-Disposition of Accumulations Upon or After a
Break in Service
UBEN112 Defined Contribution Plan and Tax Deferred 403(b)
Plan-Disposition of Accumulations-Election by Active
Employee
UBEN113 Fidelity Investments-Hardship Withdrawal Certification
UBEN114 Retirement Plans - Designation of Beneficiary
UBEN115 Defined Benefit Limit (IRC Section 415) Estimate - Request
for Calculation
UBEN118 Defined Contribution Plan and Tax-Deferred 403(b) Plan -
Telephone Transfer Authorization
UBEN120 Defined Contribution Plan and Tax-Deferred 403(b) Plan -
Telephone Transfer Confirmation
UBEN123 UCRP Tier Two Service Credit Conv.-Buyback Information
Request/Declination
UBEN124 UCRP Tier Two Service Credit Conv.-Buyback Election/
Declination
UCRS151 Annuitant Check
UCRS152 Refund Check
UCRS153 DepCare Check
UCRS154 Surepay Statement of Benefits, Reductions, and Adjustments
UCRS155 DepCare Reimbursement Request
UCRS156 Application for UCRP Disability Income
UCRS160 Authorization for Surepay Automatic Deposits
UCRS161 Tax-Deferred 403(b) Plan Loan Program Application
UCRS165 Defined Contribution Plan and Tax-Deferred 403(b)
Plan-Request for Minimum Distribution
UCRS166 Tax-Deferred 403(b) Plan Request for Refund of Excess
Contributions
UCRS168 Retirement Deduction Adjustments
UCRS169 UCRP Service Credit Buyback Information Request
UCRS170 UCRP Service Credit Buyback Election
UDEV100 Gift/Private Grant Acceptance Report
UDEV100-1 Campus Gift Acceptance Report - Berkeley
UDEV100-2 Gift/Private Grant Acceptance Report - San Francisco
UDEV100-3 Gift Acceptance Report - Davis
UDEV100-4 Campus Gift Acceptance Report - Los Angeles
UDEV100-6 Gift/Private Grant Acceptance Report - San Diego
UDEV100-7 Gift/Private Grant Acceptance Report - Santa Cruz
UDEV100-8 Gift/Private Grant Acceptance Report - Santa Barbara
UDEV100-9 Gift/Private Grant Acceptance Report - Irvine
UDEV104-2 Gift/Private Grant Transmittal - San Francisco
UDEV104-4 Departmental Gift Transmittal Los Angeles
UFIN114 Travel Advance Request
UFIN114-2 Travel Advance Request - San Francisco
UFIN114-3 Travel Advance Request - Davis
UFIN114-8 Travel Advance Request - Santa Barbara
UFIN116 Intercampus Order and/or Charge
UFIN116-1 Interdepartmental Order and/or Charge - Berkeley
UFIN161 State Claim for Reimbursement
UFIN162 No Warrant State Claim
UFIN162-8 No Warrant State Claim - Santa Barbara
UFIN220 Monthly Summary of Wire Transfers for Campus Revolving Funds
UFIN288 Financial Journal
UFIN1520 Transfer of Funds for Local Use Only
UFIN1520-1 Transfer of Funds for Local Use - Berkeley
UFIN1520I Interlocation Transfer of Funds
UP10A Purchase Order - (Unique to each campus)
UP10B Purchase Requisition - (Unique to each campus)
UPAY585 State Oath of Allegiance/Patent Agreement
UPAY694 U.S. Savings Bonds, Series EE Payroll Deduction Authorization
UPAY717 DepCare/TIP Salary Re-education Agreement
UPAY718 Life and AD&D Insurance-Designation of Beneficiary
UPAY726 Benefits Eligibility Level Indicator-Assignment or
Reassignment
UPAY727 Opt Out or Loss of Other Group Coverage Certification
UPAY728 Executive Life Insurance-Participation Election
UPAY735 Benham California Tax-Free Municipal Funds - Payroll
Deduction Agreement
UPAY744 Medical Plan-Enroll/Change/Cancel
UPAY745 Disability, Life, AD&D Enroll/Change/Cancel
UPAY746 Dental, Optical Services and Legal Plans-Enroll/Change/Cancel
UPAY752 Defined Contribution Plan Pretax Account - Fund Designation
UPAY754 Severance Pay Adjustment Sheet
UPAY755 Health Science Severance Pay Contribution Unit Table
UPAY756 PPP810 Run Specification
UPAY757 PPP820 Run Specification
UPER128 Performance Evaluation
UPER129 Probationary Period Report of Performance Evaluation
W2 Wage and Tax Statement
W2C Statement of Corrected Income and Tax Amounts
W2P Statements for Recipients of Annuities, Retired Pay, or IRA
Payments
W4 UC Employees Federal/State Withholding Allowance Certificate
W5 UC Earned Income Credit Advance Payment Certificate
B. Other Forms (Voluntary Participation) These forms may be ordered
through the Planned Purchasing Program but there is no requirement to do
so. Any form may be ordered through this program so as to take
advantage of the quantity discounts available.
Form Number Form Name
CS4-8 Central Stores Requisition - Santa Barbara
CS4B-8 Central Stores Requisition - Back Order - Santa Barbara
E0050 Request for Time Off With Pay - Berkeley
E0110 Attachment Memo - Berkeley
E0120 Attendance and Work Record Form - Berkeley
E0160 Cancellation of Invoice (Sundry Debtor) - Berkeley
E0165 Career Development Plan - Berkeley
E0170 Cartage Memo, U.P.S. - Berkeley
E0180 Central Duplicating Request - Berkeley
E0227 Departmental Purchase Authorization - Berkeley
E0240 Direct Book Order - Berkeley
E0265 Employee Development Advance - Berkeley
E0295 Employee Request for Training - Berkeley
E0300 Equipment Inventory Modification Request - Berkeley
E0320 Physical Resources Requisition - Berkeley
E0330 Fee Refund Authorization - Berkeley
E0371 UCB Storehouse I.O.C. - (2 part) - Berkeley
E0372 UCB Storehouse I.O.C. - (3 part) - Berkeley
E0373 UCB Storehouse Monthly Statement - Berkeley
E0374 UCB Storehouse Supply Agreement Order - Berkeley
E0376 UCB Storehouse I.O.C.
E0400 Job Vacancy Listing - Berkeley
E0401 Key Control Agreement (Form 84) - Berkeley
E0430 Payment Request to Student (Form 26) - Berkeley
E0525 Miscellaneous Receipt Detail - Berkeley
E0526 Rebudget Request for Gift or Private C&G Funds
E0530 Recording/Service Number Request - Berkeley
E0610 Request for Approval/Withdrawal - Berkeley
E0630 Request for Quotation - Berkeley
E0680 Staff Service Award Request - Berkeley
E0700 Invoice (Sundry Debtor) Extra Sheet/Pads - Berkeley
E0705 Invoice (Sundry Debtor) Unnumbered - Berkeley
E0710 Invoice (Sundry Debtor)
E0730 Telecommunications Equipment and Services Requisition -
Berkeley
IN14-Berk Invoice (Sundry Debtor) - Berkeley
OAR111-1 Midterm Status Mailer - Berkeley
OAR525-1 Cumulative Grade Report - Berkeley
RM-2 Request for Establishment of Record Disposition Schedule
U5G-2 Check Request for Entertainment - Meeting Expenses - San
Francisco
U196-9 Application for Foreign Travel Expenses - Irvine
U242 Signature Authorization or Cancellation
U242-1 Signature Authorization or Cancellation - Berkeley
U242-3 Signature Authorization or Cancellation - Davis
U245 Interoffice Memorandum
U465-1 Equipment Register - Berkeley
U466-1 Equipment Inventory File (Research) - Berkeley
U1034 Public Voucher for Purchases and Services Other Than
Personal
U1034-1 Public Voucher for Purchases and Services Other Than
Personal - B
U1034-6 Public Voucher for Purchases and Services Other Than
Personal - SD
U1034-8A Public Voucher for Purchases and Services Other Than
Personal - SB
U1034-8B Public Voucher for Purchases and Services Other Than
Personal - SB
U1034-9 Public Voucher for Purchases and Services Other Than
Personal - I
U1403 Vendor Register
U1404-1 Closing Worksheets
U14l4-4MC UCLA Medical Center Vendor Checks
U1515 Removal Expense Allowance Agreement
U1607 Job Description
U1607-1 Job Description - Berkeley
U1607-8 Job Description - Santa Barbara
U5416 SurePay Statements
U5416-1 SurePay Statements - Berkeley
U5416-7 SurePay Statements - Santa Cruz
U5416-8 SurePay Statements - Santa Barbara
U5416-9 SurePay Statements - Irvine
UCSA001 Personnel Activity Report (Unique to each campus)
UEQP100 Equipment Property Card
UEQP100-1 Equipment Property Card - Berkeley
UEQP101-7 Equipment Inventory Modification Request - Santa Cruz
UFIN031 Purchase Order Authorization Continuation Sheet
UFIN100 Vendor Check Adjustment
UFIN100-1 Vendor Check Adjustment - Berkeley
UFIN118 Cost Sharing Contribution Report
UFIN120B Non-Payroll Expenditure Adjustment Request
UFIN120B-4 Non-Payroll Expenditure Adjustment Request - Los Angeles
UFIN120-2 Non-Payroll Cost Transfer - San Francisco
UFlN150 Intercampus Financial Transfer Attachment Memorandum
UFIN169 Rush Sticker
UFIN170 Urgent Sticker
UFIN275 Invoice Coding Skirt
UFIN284 Lien Voucher
UFIN284-9 Lien Voucher - Irvine
UFIN285 Lien Adjustments
UFIN287 Data Processing Batch Slip
UFIN1520-3 Transfer of Funds Request - Davis
UFIN1520B Transfer of Funds Request Continuation
UFIN152OR-5 Riverside Campus Transfer of Funds Request
UFIN1521 Budget Adjustment Journal
UFIN1530 Account Profile
UFIN1530-1 Manual of Accounts Form - Berkeley
UFIN1531 Account Profile Changes
UFIN1531-8 Account Profile - Santa Barbara
UISAS160 Service Request - UISAS
UISAS258 UCOP Kaiser Building Change Order Request
UISAS259 UPS Shipment Request - UISAS
UISAS260 UCOP Kaiser Center Parking Cancellation
UPl0C-2 After the Fact Purchase Authorization - San Francisco
UPAY539 Overpayment/Underpayment Worksheet
UPAY539-1 Overpayment/Underpayment Worksheet - Berkeley
UPAY539C-9 Check Cancellation Worksheet - Irvine
UPAY539H-9 Hand Drawn Check Worksheet - Irvine
UPAY5390-9 Overpayment Worksheet - Irvine
UPAY543 Payroll Adjustment Worksheet
UPAY543A-1 Payroll Adjustment Worksheet Unclaimed Checks - Berkeley
UPAY543F-1 Stop Payment-Replacement Check Request - Berkeley
UPAY543G-1 Payroll Adjustment Worksheet RE/DS - Berkeley
UPAY544 Personal Data Form (Unique to each campus)
UPAY544A-1 Payroll Earnings Distribution Authorization - Berkeley
UPAY545 Gross to Net Table
UPAY546 Bank Table
UPAY547 Federal Tax Tables
UPAY548 California Tax Tables
UPAY549A Benefits Rates Table - Life/EE-PDTD
UPAY549B Benefits Rates Table - Accidental Death & Dismemberment
UPAY551 Benefits Rates Table - Dental Insurance
UPAY552 Home Department Table
UPAY553 Data Element Table
UPAY554 System Messages Table
UPAY555 Benefits Rates Table - Medical Insurance
UPAY556 Title Code Table - Pay Rate Data
UPAY557 Title Code Table - Full Academic and Staff
UPAY558 Title Code Table - Short Form
UPAY559 System Parameters Table
UPAY560 Personnel Action Form
UPAY560-1 Personnel Action Form - Berkeley
UPAY560-4 Personnel Action Form - Los Angeles
UPAY560-6 Personnel Action Form - San Diego
UPAY560-9 Personnel Action Form - Irvine
UPAY563 Data Base Maintenance Worksheet
UPAY563-1 Data Base Maintenance Worksheet - Berkeley
UPAY564 One-Time Payroll Payment Authorization
UPAY564-1 One-Time Payroll Payment Authorization - Berkeley
UPAY565A Bargaining Unit Table
UPAY565B Bargaining Unit Table
UPAY565C Bargaining Unit Table
UPAY571 System Calendar
UPAY572 Report Description Table
UPAY573 Sabbatical Leave/Special Leave of Absence
UPAY573-1 Sabbatical Leave/Special Leave of Absence - Berkeley
UPAY573-6 Sabbatical Leave/Special Leave of Absence - San Diego
UPAY573-9 Sabbatical Leave/Special Leave of Absence - Irvine
UPAY574 Personnel Action Form Request
UPAY574A-l Personnel Action Form Request Berkeley
UPAY575 Campus Control Record
UPAY580 Payroll Modification Worksheet
UPAY580-1 Payroll Modification Worksheet Berkeley
UPAY581 Rate Adjustment Pay Scale Worksheet
UPAY590 Mass Account/Fund Change Worksheet
UPAY590-1 Mass Account/Fund Change Worksheet - Berkeley
UPAY591 Mass Title Code Change Worksheet
UPAY600 Batch Control Card
UPAY600-1 Batch Control Card - Berkeley
UPAY620 Data Base/Employee Record Display Request
UPAY630 System Control Record
UPAY640A Payroll Maintenance Worksheet I
UPAY640A-1 Payroll Maintenance Worksheet I - Berkeley
UPAY640B Payroll Maintenance Worksheet II
UPAY640B-1 Payroll Maintenance Worksheet II - Berkeley
UPAY640C Payroll Maintenance Worksheet III
UPAY640D Payroll Maintenance Worksheet IV
UPAY640D-1 Payroll Maintenance Worksheet IV - Berkeley
UPAY640D-8 Payroll Maintenance Worksheet IV - Santa Barbara
UPAY641 Payroll Disbursement Run Specification
UPAY641-1 Payroll Disbursement Run Specification - Berkeley
UPAY642 One-Time Check Disposition Override
UPAY643 Deduction/Reduction Report Request
UPAY644A Payroll Time Reporting Worksheet
UPAY644A-1 Payroll Time Reporting Worksheet - Berkeley
UPAY644A-8 Payroll Time Reporting Worksheet - Santa Barbara
UPAY644B Special Payroll Time Reporting Worksheet
UPAY644B-1 Special Payroll Time Reporting Worksheet - Berkeley
UPAY644C Payroll Additional Pay Time Reporting Worksheet
UPAY644C-1 Payroll Additional Pay Time Reporting Worksheet - Berkeley
UPAY644C-2 Payroll Additional Pay Time Reporting Worksheet - San
Francisco
UPAY644C-8 Payroll Additional Pay Time Reporting Worksheet - Santa
Barbara
UPAY644D Payroll Time Reporting Adjustment Worksheet
UPAY644D-1 Payroll Time Reporting Adjustment Worksheet - Berkeley
UPAY644D-2 Payroll Time Reporting Adjustment Worksheet - San Francisco
UPAY644D-8 Payroll Time Reporting Adjustment Worksheet - Santa Barbara
UPAY644E Expanded Payroll Time Reporting Worksheet
UPAY644E-1 Absence Notice for Salary Deduction - Berkeley
UPAY644E-4 Absence Notice for Salary Deduction - Los Angeles
UPAY644E-9 Expanded Payroll Time Reporting Worksheet - Irvine
UPAY644F Expanded Special Payroll Time Reporting Worksheet
UPAY644F-4 Special Payroll - Los Angeles
UPAY644G-1 Payroll Additional Pay Time Reporting Worksheet - Berkeley
UPAY644G-4 Credit Special Payroll - Los Angeles
UPAY644H-4 Retroactive Special Payroll - UCLA
UPAY644LR-9 Payroll Leave Reporting Worksheet - Irvine
UPAY644S-2 Absence Notice for Salary Deduction - San Francisco
UPAY644S-4 Absence Notice for Salary Deduction - Los Angeles
UPAY645 Employment History Display Request
UPAY646 Payroll Expenditure Transfer
UPAY646-1 Payroll Expenditure Transfer - Berkeley
UPAY646-2 Payroll Expenditure Transfer - San Francisco
UPAY646-4 Payroll Expenditure Transfer - UCLA
UPAY646-8 Payroll Expenditure Transfer - Santa Barbara
UPAY646-9 Payroll Expenditure Transfer - Irvine
UPAY647 Payroll Batch Control Form
UPAY648 Corrections to Payroll Batch Control Form
UPAY649 Balance Adjustment Worksheet
UPAY650 Description of Service Table
UPAY651 Payroll Deduction Cancellations Parking
UPAY651-3 Payroll Deduction Authorization for Parking Fee
UPAY653 Deduction Worksheet
UPAY653A-1 Deduction Worksheet - Berkeley
UPAY654 Control File Maintenance List & Restore Requests
UPAY655 Table Delimiter Segments
UPAY656 Payroll Control File Run Specifications
UPAY660 Program Run Specifications
UPAY660A Program Run Specifications
UPAY661 Run Specification Layout
UPAY662 Payroll Transaction Deletion Worksheet
UPAY664 Mass Purge Worksheet
UPAY666 Employee Organization Insured Benefit Program
UPAY667 Advance EIC Payments Tables
UPAY669 Employee Organization Membership Payroll Deduction
Authorization
UPAY672 Bargaining Unit Deduction Change Worksheet
UPAY673 PPP765 Run Specification
UPAY674 PPP125 Run Specification
UPAY676 Benefits Rates Table - Retirement
UPAY677 PPP910 Run Specification
UPAY678 PPP930 Run Specification
UPAY680 PPP780 Run Specification
UPAY681 Taxable Life Premium Table
UPAY682 Costing Designated Fund Table - Table 18
UPAY683 PPP990 Run Specification
UPAY685 Costing Non-Designated Fund Table - Table 19
UPAY686 Performance Incentive Award-Costing Transactions
UPAY687 PPP980 Program Run Specification
UPAY688 Costing Action Table - Table 18
UPAY689 Mass Distribution Unit Code Change Worksheet
UPAY690 Rate Adjustment Range DUC Table
UPAY691A Prior Period Table
UPAY691B Prior Period Table
UPAY692 Rate Adjustment Titles to Report
UPAY693 Rate Adjustment Biweekly Effective Date
UPAY697 Benefits Rates Table LTD
UPAY698 Bond Reporting Override
UPAY702 SurePay Payroll Earnings Distribution Authorization
UPAY702-2 Payroll Wage Disposition Request - San Francisco
UPAY702-4 Payroll Wage Disposition Request - UCLA
UPAY703 SurePay Bank Table
UPAY704 PPP430 Run Specification
UPAY707 Workers' Compensation Rate Table
UPAY708 Benefits Rate Table - Vision Insurance Premiums
UPAY709 PP1750 Program Run Specification
UPAY710 Program Run Specification
UPAY711 PPP670 Program Run Specification
UPAY712 Benefits Rates Tables: Gross-to-Net Rates/Amounts
UPAY714 Benefits Rate Table - Group Legal Services Plan
UPAY719 Leave Accrual Table
UPAY720 Leave Rate Table
UPAY721 Work Study Program Table
UPAY722 PPP680 Program Run Specification
UPAY723 Expanded SurePay Message File
UPAY724 Employee Support Program Rate Table
UPAY725 Timesheet Reprint Request
UPAY730 PPP510 Program Run Specification
UPAY731 PPP600 Program Run Specification
UPAY732 PPP600 W-2 Special Handling Overrides
UPAY733 PPP600 W-2 ID Number Selection/Overrides
UPAY734 PP1730 Program Run Specification
UPAY736 Payroll Bank Disbursement - WFB Run Specification
UPAY737 Foreign Country Table
UPAY738 PPB790 Program Run Specification
UPAY739 Data Element Table
UPAY740 Rush Check Abeyance File Transaction Override Form
UPAY741 Rush Check Option 1 Request
UPAY742 Rush Check Option 2 Request
UPAY743 Rush Check Option 3 Request
UPAY747 PPRCABEY Run Specification
UPAY748 PPRCREDIT Run Specification
UPAY749 PPRCVNDR Run Specification
UPAY750 Online Help Text Maintenance
UPAY751 PPP590 Program Run Specification
UPER104 Employment Application
UPER104-1 Employment Application - Berkeley
UPER104-7 Employment Application - Santa Cruz
UPER104-8 Employment Application - Santa Barbara
UPER128-3 Employee Performance Appraisal - Davis
UPER131 Formal Grievance
UPER136 Office of the President - Job Vacancy Listing
UPER149-8 Management and Administrative Program (MAP) Performance
Appraisal
UPER150 Administrative and Professional Staff (A&PS) Performance
Evaluation
UPER150-1 A&PS Employee Performance Evaluation - Berkeley
UPER150-2 A&PS Performance Evaluation - San Francisco
UPER150-8 Administrative and Professional Staff (A&PS) Performance
Appraisal
UPER151 UCOP Position Information Packet
URET104 UCRS Record of Checks Received
USFAIOO Financial Aid Offer Letter
USFA100-2 Financial Aid Offer Letter - San Francisco
USFA100-7 Financial Aid Offer Letter - Santa Cruz
USFA100-8 Financial Aid Offer Letter - Santa Barbara
USFA115-5 Financial Aid Check Request - Riverside
USFA130 Fee Payment Authorization
USFA130-9 Fee Payment Authorization - Irvine
USIR115 Class Data
USIR115-1 Class Data - Berkeley
USIS100-1 Student Record File - Berkeley
USIS200-1 Class Master - Berkeley
USIS300-1 Study List - Berkeley
USIS410 Student History Card
USIS410-1 Student History Card - Berkeley
UTRS156 Treasurer's Financial Journal - Type Entry 56
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