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UConn Health has begun the process of resuming routine appointments and elective procedures, and we are committed to creating the safest possible environment for our patients, employees, and visitors.
Coronavirus (COVID-19) Information
Banner LDCA Form This form is to be used to authorize a change in labor distribution for one employee for a prior period.
Banner Access Request Form to request UConn Health Banner access.
Check Tracer Form to request tracking of potentially lost UConn Health vendor/reimbursement checks.
Conference Facility Reservation Contract hotel and conference facility authorization.
IRS W-9 IRS taxpayer identification form.
Mileage Reimbursement – new rate Form for mileage reimbursement January 01, 2020 and after.
Mileage Reimbursement – old rate Form for mileage reimbursement December 31, 2019 and prior.
Miscellaneous Payment Reimbursement Non-PO expense reimbursement form.
Remittance Form Institutional deposit form.
Signature Authorization Signature Authority will be granted to the requesting employee listed at right for the following funds and organizations.
Stipend/Fellowship For use in requesting payment for research subjects/student stipends/student awards. Please note that this form requires B numbers, available via the Person Lookup tool.
Transfer Invoice Form CO-608 Transfer Invoice for billing between State entities.
Miscellaneous Transfer Voucher Transfer voucher for billing between UConn Health departments or requesting a journal voucher.
Travel Reimbursement – new rate Form to obtain reimbursement for allowable UConn Health business travel expenses, on or after January 01, 2020.
Travel Reimbursement – old rate Form to obtain reimbursement for allowable UConn Health business travel expenses, on or before December 31, 2019.
Vendor Payment Authorization This form may be used when requesting a payment to a vendor for the following: license renewal, subscription renewal, membership dues, etc.
Branch Fund Request This form is used to establish a “petty cash” fund. Branch Funds are used to make change for patient payments, or miscellaneous emergency purchases.
Borrower Loan Deferment This form is used by borrowers who want to defer their loans while they are in residency or furthering their education in health professions.
Branch Fund Reporting Explain any discrepancy between this total and the Authorized Balance.
Note: Read the updated Branch Fund Procedures. 03/22/19
FERPA Release Form This form must filled out for the Bursar’s Office to discuss any/all billing matters with a designee set up by the student. Without this form the office cannot release any information to anyone other than the student enrolled.
Identity Theft Prevention Contains information about the Identity Theft Prevention Program.
Remittance Form This form must accompany any and all deposits for cash and checks. Please fill in all information or deposits will not be able to process.
Remittance Form – Patient Services Use this form to deposit patient service payments made by coin, cash, or check. Please fill in all information or deposits will not be able to process.
Remittance Form – Patient Services – Credit Cards Only
Use this form to deposit patient service payments made only by a credit card. Please fill in all information or deposits will not be able to process.
Vendor Credit Card Application This form is used to apply for a credit card terminal and merchant number to do business on behalf of the institution via credit cards.
U.S. Visa History Form Is strictly confidential and is not associated with immigration or visa classification. It is used for tax withholding and needs to be filled out when a Social Security Number is not available.
Bradley International Airport Parking Map Map of the state authorized parking areas at Bradley International Airport, for official travel.
Function Booking Sheet All events booked using institutional funds must be approved prior to services being processed.
Guest Travel Authorization This form must be completed and authorized before it is considered valid. All guests or candidates must be on file in the Bursar’s Office.
Hotel/Facility Authorization Use this form for making reservations with an approved guest TA. Provide hotel a copy of form. Complete all information. If UConn Health charges admission, not tax exempt. If UConn Health doesn’t collect revenue, it is tax exempt.
Travel Authorization Request This form must be filled out for any and all travel, including no-cost to state travel. All signature authorizations must be filled in for a TA to be considered AUTHORIZED and VALID.
Travel Advance Request Complete sections A and B and forward to Bursar’s Office, 16 Munson Road, MC 5105.
UConn Health Corporate Credit Card Form to apply for a UConn Health corporate credit card.
Exception to Travel Policy Request This form should be completed to request approval for expenditures that are not allowed within the travel policy but which the traveller would like to be considered for reimbursement
Travel Reimbursement Checklist A one sheet guide for pre-checking travel submittals prior to sending for processing
Business Meal Request Form This form is used to request pre-authorization for a business meal associated with a valid business purpose. It requires an agenda, attendee listing, and consideration of per diem cost caps.