Forms

Payroll and Tax Forms

• Form I-9: Employment Eligibility Verification
• Form W-4: Federal Income Tax Withholding
• Form W-4: Iowa Income Tax Withholding
• W-2 Options
• W2 Notice/Instructions for Employee
• Direct deposit changes must be made via NorseHub (instructions)

Additional Employment Forms

• Volunteer Agreement Form
• Temporary Employee Offer Worksheet
• Request to Hire Form
• Job Description Template
• Remote Work (Regular) Form
• Remote Work (Ad Hoc) Form
• Employee Chosen Name Application
• Minors on Campus Training Workbook
• Report a Workplace Injury
• Request a Name Tag

Employee Benefit Forms

• TIAA Retirement contribution changes should be submitted via Norse Hub
• TIAA Rollover Form (to roll monies into your Luther retirement account)
• UMR Health Insurance Enrollment & Change Form
• UMR Health Insurance Claim Submission Form
• Express Scripts Prescription Drug Claim Submission Form
• 2024 Wellness Activity Form
• Optum Bank Health Savings Account (HSA) Authorization Form
• Optum Bank Health Savings Account (HSA) contribution changes should submitted via Norse Hub
• Flexible Spending Account Enrollment & Change Form
• Flexible Spending Account Health Care Reimbursement Form
• Flexible Spending Account Dependent Care Reimbursement Form
• Delta Dental Insurance Enrollment & Change Form
• Staff Parental Leave Request Form
• Faculty Parental Leave Request Form
• Moving Expense Form for New Employees
• Part-Time Tuition Credit Application (faculty/staff taking a class)