Business and Service Forms

Access Control Executive Designation Form

Accommodation Under the Americans with Disabilities Act, Employee Request for

Accommodation Under the Americans with Disabilities Act, Student/Resident Request for

Accounting of Disclosures of Protected Health Information

Acknowledgement of Receipt of Notice of Privacy Practices | (Spanish version)

Agreement - Clinical Study (Template)

Agreement - Sponsored Research (Template)

Alcoholic Beverages on Campus (faculty/staff only), Request for

Alcoholic Beverages on Campus for Student Organizations, Request for

Amendment Denial Letter

Answer Sheet Request Form

Applicant Log for the Position Of:

Approval and Payment to Employee for Additional Services, Request for

Audiovisual/Classroom Support Request Form

Authorization of Signature, Request for

Benefits Forms

Billing for Studies Involving Human Subjects

Biographical Data Sheet

Bookstore Departmental Requisition

Bookstore Textbook and Manual Request Form

Business Card Request Form

Top of Page

Cash Receipt Deposit Voucher

Certificate of Proposal

Change of Chairman or Head

Chemical Waste Pickup Request

Clinical/Adjunct Faculty Appointment Letter

Clinical Trial Study Information to UT Medicine

Communications Service Request Form

Confidentiality/Security Acknowledgement

Conflicts of Interest Reporting Form

Consent and Agreement for Treatment

Consortium Agreement Template - HSC As Prime Awardee

Consortium Agreement Template - HSC As Subawardee

Contractors and Vendors ID Request Form

Course Evaluation Request Form

Credit Card Merchant Request

Top of Page

Data Use Agreement

Debarment Certification

Departmental Postage Request

Departure for International Visitors, Confirmation of

Deposit Request-Office of Sponsored Programs

Direct Deposit Authorization Form

Dispose of State Records, Request for Authority to

Dual Positions of Honor, Trust or Profit, Request for Approval of

Electronic Funds Transfer Form

Electronic Storage Device Disposal Request

Eligibility to Handle Select Biological Agents or Toxins, Annual Statement of

E-mail Authorization Agreement

Emergency Requisition Justification

Employee/Independent Contractor Classification Checklist

Employee Separation Form (UT System)

Employer's First Report of Injury or Illness

Equipment Transfer Request

Exam Scoring Request Form

Exemption from Withholding for Independent (and Certain Dependent) Personal Services of a Nonresident Alien Individual

Exit/Clearance Form

Extension of Stay, Request for

Top of Page

Facilities Management Request for Department Funded Move

Facilities Management Request for Department Funded Set-Up

Facilities Management Request for Department Funded Work

Facilities Management Request for FM Maintenance

Faculty CA-1: Request for Clinical or Adjunct Faculty Appointment

Faculty CI-1: Supplement to Faculty Appointment Packets

Faculty CJ-1: Request for Cross or Joint Appointment

Faculty CJ-1: Supplement to Joint Appointment Packets

Faculty FA-1: Request for Faculty Appointment of Associate Professor or Professor

Faculty FA-2: Request for Initial Faculty Appointment

Faculty FA-3: Request for Initial HSC and VA Appointment

Faculty FA-4: Request for Faculty Promotion from Instructor

Faculty PA-1: Request for Promotion in Rank

Faculty Recruitment Report

Fitness for Duty Certification

FMLA: Certification of Physician

FMLA: Department Notification to Employee

FMLA: Request for Time Off

Fellowship (Stipend) Award Authorization

Flex Time, Request for

General Services Shipping Request

General Services Storage Request

Grants, NIH Modular Budget for HSC Internal Use

HIPAA Patient Privacy Forms

Hotel Occupancy Tax Exemption Form

Human Subjects Letter to NIH

Hybridoma Facility Service Request Form

Top of Page

ID Card Request Form

Information Management and Services Service Request Form

Instrumentation Services Service Request Form

Inter-Department Transfer Voucher

International Visitor Data

Invoice

I-9 Employment Eligibility Verification

Top of Page

J Certificate of Eligibility Application Form

J-2 EAD, Apply for/Renew

Lease of Building Space Informational Questionnaire

Letter for Misdirected Fax

Library Borrower Registration Form

Library Document Delivery Services (ILLiad)

Library Loansome Doc Delivery (HSC affiliates)

Library/Ovid Online Registration Form

Library Purchase Request Form

Library Reserve Material Form

Linen Service, Authorization for

Linen Service Requisition

Local/State Voucher

Top of Page

Mail Services Outgoing Mail Project ID Number Change/Verification Form

Management Oversight Questionnaire

Memorandum of Understanding for Faculty with VA-UTHSCSA Joint Appointments

Monthly Time Report

Multimedia Production Services Service Request Form

Name Change Form - Former Employees

Notification of Faculty Vacancy

Notification of an On-the-Job Injury

Notification of Intent to Hire Academic Candidate

Top of Page

Patient Authorization for Release of Health Records | (Spanish version)

Patient Privacy Forms (HIPAA)

Payment by Electronic Funds Transfer

Peptide Request Form

Performance Review for Classified and A&P Employees

Performance Review for New Employees (Probationary)

Petty Cash Fund Request

Petty Cash Reimbursement Voucher

Position Description Questionnaire

Post-Employment EEO/AA Form

Post-Employment Information of Veteran Status

Postal Service Nonprofit Standard Mail

Postal Service Postage Statement

Printing Services Service Request Form

Prior Approval Form

Property Deletion Request

Property Removal Permit

Top of Page

Quick Reference Guide

Research Scope of Practice for Study Personnel

Research Study Patient Enrollment Form

Records Disposition Log

Records Inventory Sheet

Release Form

Reserved Purchase Order, Request for

Request for Accounting of Disclosures

Request for Amendment of Health Information

Request for Approval and Payment to Employee for Additional Services

Request for Approval of Outside Employment, Consultation, or Related Activities

Request for Confidential Communications Regarding Medical Information

Request for Transfer of Records to University Archives

Restriction Request Form

Revocation of Authorization to Release Protected Health Information

Room Reservation Request

Room Reservation Request (Edinburg only)

Room Reservation Request (Harlingen only)

Room Reservation Request (Laredo only)

Top of Page

Security Background and Sanction Check, Authorization for

Selection of Student Employee Form

Sequencing Request Form

Service on Outside Boards

Shop-Made Equipment, Record of

Sick Leave Pool Physician Statement

Sick Leave Pool Request

Sick Leave Pool Voluntary Contribution Form

Signature Authority for Property Inventory Records

Social Security Numbers - Approved Notices for Disclosure of

Sole Source Proprietary Justification for Products

Sole Source Proprietary Justification for Services

Software Deletion Request

Space Management Processing Flow Chart

Space Planning Form

Space Request Form

Special Event Parking Request Form/Worksheet

State Sales Tax Exemption Certificate

Student Travel Authorization

Student Travel Information and Release Form

Supplemental Payment to Faculty

Supplemental Report of Injury

Top of Page

Telecommuting Agreement

Transfer of Funds Request Form

Transgenic Services Request Form

Travel Contractor Usage Statement, State of Texas

Travel to Washington, D.C. - OSFR Official Form

Traveler Profile

Travel Voucher

User Security Access Request Form

UT Police Department Work Order Form (UTPD-WOF)

Vendor/Payee Set Up Form

W-4 Form for IRS

Workers' Compensation Leave of Absence

Top of Page