Home < Forms and Publications < Alphabetical Listings
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- UBEN 100 Continuation, Enrollment, Change, or Cancellation — Retiree Medical, Dental and/or Legal Plan
- UBEN 101 Medicare Advantage Prescription Drug Plan Disenrollment Form
- UBEN 106 Tax Withholding Election for UCRP Income
- UBEN 106NR Tax Withholding Election (Nonresident Aliens)
- UBEN 108 COBRA Continuation Open Enrollment and Change Form
- UBEN 109 Notice to UC of a COBRA Qualifying Event
- UBEN 110 HMO Medical Plan Transfer for Annuitants
- UBEN 116 Designation of Beneficiary—Employees
- UBEN 117 Designation of Beneficiary—Retirees, Former Employees and Others
- UBEN 119 Designation of Alternate Beneficiary—Expanded Dependent Life and AD&D
- UBEN 126 Medicare Declaration
- UBEN 131 UC Benefits Address Change Notice
- UBEN 132 Service Credit Verification Request
- UBEN 143 - CSU Defined Contribution Plan Distribution Kit for CSU Safe Harbor Participants
- UBEN 250 Declaration of Domestic Partnership--UCRP
- UBEN 253 Termination of Domestic Partnership
- UCRP/CalSTRS Concurrent Retirement Factsheet
- UCRP Disability Handbook
- UCRP Buyback Booklet, The
- UCRP IRC 415 Factsheet
- UCRP Summary Plan Description for Members with Social Security
- UCRP Summary Plan Description for Members without Social Security
- UCRP Summary Plan Description for Safety Members
- UCRP Summary Plan Description for Tier Two Members
- UCRP/CalPERS Reciprocity Factsheet
- UCRS 160 Direct Deposit--Enrollment, Change or Cancellation
- UCRS 419 Statement — Employment not Covered by Social Security
- University of California: Overview of Outreach and Recruitment, Training and Development, and Valuing Diversity Programs for Staff Employees
- UPAY 585 State Oath of Allegiance and Patent Agreement
- UPAY 717 DepCare/HCRA Enrollment Salary Reduction Agreement
- UPAY 850 Enrollment, Change, Cancellation, or Opt Out — Health and Welfare Plans
- UPAY 884 UC Pretax Transportation Deductions or Cancellation or Re-enrollment (Form is included in Pretax Transportation Program Factsheet)
- UPAY 919 DepCare/HCRA Enrollment, Change or Cancellation — Salary Reduction Agreement
