Payroll & Benefits Forms

Forms for Employees

Employee's Withholding Allowance Certificate

• W-4 Withholding Allowance [My UI Info] - Online withholding allowance
• Federal Form W-4 Employee's Withholding Allowance Certificate - Sample of blank withholding allowance certificate
• IL-W-4, Employee's and other Payee's Illinois Withholding Allowance Certificate and Instructions - Sample of blank withholding allowance certificate

Employee's Wage and Tax Statement

• W-2/1042-S/1095-C Tax Statement [My UI Info] - Online W-2/1042-W/1095-C tax statements
• Federal Form W-2, Wage and Tax Statement - Sample of blank W-2 statement that is mailed to each employee at year end

Request for Duplicate Tax Form (W-2, 1042-S and/or 1095-C)

See Reissiue Tax Forms for instructions if you have electronic delivery of tax forms.

If you are unable to access prior year tax forms, please contact University Payroll & Benefits through the UPB Customer Service Portal for your campus.

Employee's Statement of Nonresidence in Illinois

• Illinois Department of Revenue Form IL-W-5-NR, Employee's Statement of Nonresidence in Illinois

If you live in a reciprocal state (Iowa, Kentucky, Michigan, or Wisconsin) and you travel to Illinois to perform your work a majority of the time, use this form to claim exempt from Illinois tax withholding and begin withholding for your state of residence (Iowa, Kentucky, Michigan, or Wisconsin).

Certification of Non-residence

• Certification of Non-residence in Illinois [updated: 12/6/11] - Complete this form if you live outside of Illinois and perform the majority of your work outside of Illinois (if qualified and approved).

Foreign Person's U.S. Source Income Subject to Withholding

• Form 1042-S, Foreign Person's U.S. Source Income Subject to Withholding - Sample of blank statement sent to foreign national persons with earnings from the University of Illinois

Employee Statement of Employer Provided Vehicle

• Employee Statement of Employer Provided Vehicle [updated: 10/27/15] - To report usage of an employer provided vehicle for tax purposes.

Voluntary Deduction Agreement Form

• Voluntary Deduction Agreement Form [updated: 8/26/22] - This form is used to set up a voluntary agreement to repay an Illinois State Offset Accounts Receivable deduction.
• UPB Payroll Deduction Revocation Form - This online form is used to revoke deductions from a Voluntary Deduction Agreement

Benefits

• Please see the Benefits Forms page on the U of I System HR website.

Payroll Distribution Forms

Direct Deposit or Pay Card

• Direct Deposit or Pay Card [My UI Info] - If you are unable to review or make direct deposit changes on line, please contact University Payroll & Benefits through the UPB Customer Service Portal for your campus.

Request for Pay Loan

• Request a Pay Loan [updated: 10/9/2020]

Return Payroll Checks

• Return payroll checks to University Payroll [updated: 3/15/18]

Loss or Theft of Checks

• Affidavit of Loss or Theft of Check [updated: 4/13/07]

Payroll Adjustments & Payments

Submit Adjustments

• ANA - Adjustment Notification Application
• PARIS - Payroll Adjustment Request Interface System

See the Applications page for more information about ANA and PARIS.

Overpayments

• GC91 - Documentation of Payroll Overpayments Charged to Sponsored Projects [updated: 10/27/17] - Required for payroll overpayments involving a sponsored project or grant.

Employee Recognition Awards

• Employee Recognition Awards Template for Multiple Recipients [updated: 3/9/15] - Submit payment requests for all recipients at an awards ceremony.

Mass Time Entry Feeder Requests

• Feeder Systems Evaluation [updated: 09/14/20]
• Feeder Agreement UIC [updated: 09/14/20]
• Feeder Agreement UIUC-UIS [updated: 09/14/20]