The chart below lists forms that must accompany various types of EDB
Entry/Update transactions. Some forms must be sent to an Office of Record due to the
requirements of regulatory agencies even though the data they contain is entered directly
into the EDB by the department (e.g., citizenship and tax forms). Other forms (e.g.,
parking deductions forms) must be sent to a central campus office which is responsible for
updating the EDB.
| Form Name | Form No. | Office of Record |
| Academic Affirmative Action Selection & Compliance | Academic Personnel Office | |
| Academic Sabbatical/Leave of Absence | Academic Personnel Office | |
| Benefits Enrollment/Opt Out Form | UPAY 850 | HR - Benefits |
| Certificate of Foreign Status for Federal Tax Withholding | UC W-8BEN | Campus Payroll |
| • Staff Employee Requisition • UCLA Staff Employment Offer Verification Notice • Employee's Resume, Employment Application, or Staff Transfer Application (for non-academic career appointments in non-clerical positions) |
HR-Employment | |
| Employment Eligibility Verification | I-9 | Campus Payroll |
| Job Description (for non-academic career appointments) | HR-Compensation | |
| Life and AD&D - Designation of Beneficiary | UPAY 718 | HR - Benefits |
| ***Out of State Withholding Form | UPAY 830 | Campus Payroll |
| ***• Parking Services Payroll Deductions Authorization | 1615LA | Campus Parking |
| ***• Parking Services Payroll Deductions Cancellation | 1615CLA | Campus Parking |
| State Oath of Allegiance and Patent Agreement | UPAY 585 | Campus Payroll |
| Statement Concerning Your Employment in a University Position Not Covered by Social Security | UCRS 419 | UC HR/Benefits - Records Management |
| Tax Treaty Statement (Plus applicable attachments, refer to Sec B) | Campus Payroll | |
| • UCLA Interview and Hire Record - Career
Staff Employees • UCLA Quarterly Training Record (Both Forms - 3 year retention) |
Form A Form E |
Department (Career appointments) Department |
| Unemployment Insurance Termination Report | U5602 | CHR - Unemployment Coordinator |
| University of California Pretax Transportation Deduction or Cancellation or Re-Enrollment | UPAY 884 | Campus Parking |
| Withholding Allowance Certificate | W-4 | Department |
| Work-Study Referral Form | UPAY 759-4 | Department (Work Study Hires) |
| UCRP - Designation of Beneficiary | UBEN 114 | UCOP |
| ++ UCLA Medical Enterprise Competency Validation Checklist | Department | |
| ++ New Employee Hospital Orientation Confirmation of Attendance | Department | |
| ++ UCLA Medical Enterprise Department Specific Orientation | Department | |
| ++ UCLA Medical Center Job Description | Department | |
| ++ UCLA Medical Enterprise Equipment Competency Validation | Department | |
| ++ Confidentiality of Patient and Employee Information | Department |
Many of the required forms are available (or can be ordered) on the web from one of
the following sources:
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