Human Resources

Chapter 6 BENEFITS ADMINISTRATION

Sections in this Chapter:

6.10	Types of Leave
6.15	Education Financial Assistance
6.17	Sick Leave Insurance Program
6.20	Workers' Compensation
6.25	Health Insurance
6.30	Dental Insurance
6.35	Life Insurance
6.40	Long-term Disability Insurance
6.45	Reserved
6.50	Deferred Compensation and Tax-Sheltered Annuities
6.70	Pretax Premium Conversion Program
6.80	Flexible Spending Accounts
6.85	Donated Leave for Employees
6.87	Donated Leave for Immediate Family Members
6.90	Family and Medical Leave Act Policy
	Family and Medical Leave Act (FMLA) Required Posting from the U.S. Department of Labor

Related Department Rules:

None

Related Performance & Development Solutions Training Available:

None

Forms Referenced in This Chapter:

Application for Education Leave and/or Education Financial Assistance 552-0304	PDF | Word Document
Donated Leave for Catastrophic Illness Application 552-0611	PDF
Donated Leave for Catastrophic Illness Contribution 552-0612	PDF
Donated Leave for Catastrophic Illness Request 552-0620	PDF | Word Template
Donated Leave for Catastrophic Illness Tracking 552-0628	PDF
Donated Leave for Catastrophic Illness Immediate Family Member Application 552-0639	PDF
Donated Leave for Catastrophic Illness Immediate Family Member Contribution 552-0640	PDF
Donated Leave for Catastrophic Illness Immediate Family Member Request 552-0641	PDF | Word Template
Donated Leave for Catastrophic Illness Immediate Family Member Tracking 552-0642	PDF
Family and Medical Leave Act (FMLA) Application 552-0599	PDF
Family and Medical Leave Act (FMLA) Required Posting from the US Department of Labor	PDF
Family and Medical Leave Act (FMLA) Leave Retention (CFN 552-0649)	PDF
Family and Medical Leave Act (FMLA) Leave Fitness for Duty Certification (FFN 552-0731)	PDF
Notice of Eligibility and Rights & Responsibilities (CFN 552-0730)	PDF
Designation Notice (WH-382)	PDF
Certification of Health Care Provider for Employee's Serious Health Condition (WH-380-E)	PDF
Certification of Health Care Provider for Family Member's Serious Health Condition (WH-380-F)	PDF
Certification of Qualifying Exigency for Military Family Leave (WH-384)	PDF
Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave (WH-385)	PDF
Servicemember Family Leave Tracking	PDF |Excel Spreadsheet
Workers' Compensation Benefit Election 552-0568	PDF | Word Document
Workers' Compensation Wage Statement 552-0679	PDF | Word Document
Workers' Compensation Status Report 552-0678	PDF | Word Document
Workers' Compensation Travel Reimbursement Request 552-0680	PDF | Word Document
Workers' Compensation First Report of Injury or Illness	PDF
Agreement for Recouping Recruitment, Retention, Education and Relocation Payments 552-0707	Word Template
Sick Leave Insurance Program Enrollment Form 552-0713	Word Document
SLIP Calculation Estimate Form	Excel
Group Insurance Direct Pay Continuation Form 552-0442	Word Document
SLIP Checklist for PAs	Word Document
Vacation Payout for 2008 Form 552-0714	Word Template

Site updated 04/29/2009

The Human Resources Enterprise of the Department of Administrative Services provides a wide variety of resources for use by department managers and supervisors, state employees, applicants, and others. We will be making those resources available on the Internet through this page in the coming months. Most of these resources will be provided in PDF format and will require the use of an Adobe Acrobat reader. If you do not have this software on your computer, you may download a free copy here: