Revised Fringe Benefit Acknowledgment Form (UB100)

Peter H. Maren, Assistant Director, University Benefits

We are pleased to announce that the Fringe Benefit Acknowledgment Form (UB100), completed by new employees when they sign up for payroll, has been revised. A sample copy is attached for your files.

The UB 100 describes the benefits available to new university employees and provides the timelines within which they are eligible to enroll in these programs and/or change existing benefits packages throughout the year.

Because this form is completed as a part of the payroll sign-up process, it is now offered as open stock at University Printing and Graphics. Please replace any old forms you may have in your department with the new forms. You may place an order for new forms by calling Printing and Graphics at 392-1134.

Thank you for updating your payroll supplies. If you have any questions or need assistance, please call University Benefits at 392-1225.