Click here for updated information as of June 27, 2017.
The following list includes many frequently used DAS-HRE forms and policies in one central location for the user's convenience. Several of these forms are also found in the Managers and Supervisors Manual and other locations on the DAS-HRE website. Where that is the case, a link to the respective Chapter in the Manual or other resource has been included.
This information is divided into the following sections for convenience:
Administrative Rules
The Department of Administrative Services' primary rule chapter is 11 of the Iowa Administrative Code.
Agency Human Resources Contacts
List of Agency Human Resources Contacts
Benefits
HRE Benefits website Benefits forms and other information can be accessed at this website.
2018
2018 Health and Dental Premiums PDF
2018 Added Value Tax Matrix PDF
2018 Deduction Schedule PDF
2018 Life Insurance Premiums PDF
2018 IowaBenefits Automatic P-1 Processing Schedule PDF
2018 SPOC Life Insurance Premiums PDF
2019
9/2018-2019 Deduction Schedule PDF
2019 Added Value Tax Table PDF
2019 IowaBenefits Automatic Health and Dental P-1 Processing Schedule PDF
2019 Iowa Benefits Automatic Life P-1 Processing Schedule PDF
2019 Dental Insurance Premiums
All employees PDF (except SPOC-covered employees)
SPOC-covered employees PDF
2019 Health Insurance Premiums
All employees PDF (except SPOC-covered employees)
SPOC-covered employees PDF
COBRA PDF
Sick Leave Insurance Program (SLIP) PDF
2019 Life Insurance Premiums
All employees PDF (All employees except SPOC-covered employees)
SPOC-covered employees PDF
Insurance Coverage Effective Dates PDF
Life Event Matrix PDF
Waiver of Life and Long-Term Disability Insurance PDF
| Benefit videos | Where to get care posters |
| Terminating an individual in IB participating in FSA | Where to get care and save PDF |
| Updating your beneficiaries in IowaBenefits | Know the cost and save PDF |
| Wellmark's Find a Provider | Know your condition and save PDF |
Employment
I-9 Form (Employment Eligibility Verification)
Note: Chrome and Firefox users must right-click and select "Save link as" to download the I-9 form to their computer. The form can then be opened in Adobe Acrobat for completion. Internet Explorer users may click the link to complete the form within the browser, or may save the form to their computer to complete.
Steps in the Hiring Process 552-0492
Confidential Personal Data Form 552-0569
Powerpoint Presentation: Revised DAS Confidential Personal Data Form Information for HRAs
Enrolling Interns in the State of Iowa Internship Program
Family and Medical Leave Act (FMLA)
Family and Medical Leave Act forms are available at the:
Family and Medical Leave website
FMLA State of Iowa Policy
Fiscal Year End Processing
Insurance Billings
Monthly Insurance Billing Reconciliation Manual PDF
CFN 005 State Share Transfer - Life & LTD form
CFN 005 Supplemental Life form
CFN 552 Refund form
CFN 552 State Share Transfer - Health & Dental form
CFN 552 Trustee Report Adjustments (TRA) form (Word)
CFN 552 Trustee Report Adjustments (TRA) form (Excel)
CFN 552 Transfer Between Carriers form
Insurance billing example PDF
Reconciliation Worksheet
Internships
Internship Development Program
Layoff
Layoff Plan Merit Covered Employees 552-0752
SPOC Layoff Plan 552-0753
Recall and Outplacement Instructions for Merit-Covered Employees 552-0231B
Retention Point Calculation Worksheet 552-0106
Samples
Sample Layoff Plan - Merit-Covered
Sample Layoff Plan - SPOC-Covered
Sample Layoff Letter - Merit Covered
Sample Layoff Letter - SPOC-Covered
Sample Recall Letter
Life Insurance
Life Insurance Claim Application PDF (to be completed by agency)
Beneficiary Statement PDF (method of benefit payment)
Long Term Disability Insurance
Please contact the Life and LTD Specilaist for application.
Manuals and Other Resources
Centralized Payroll Manuals
Managers and Supervisors Manual
Monthly Insurance Billing Reconciliation Manual PDF
Military Leave
Military Leave of Absence Manual
Iowa Code 29A.28
11 IAC 63.9(8A) Military Leave
Pay
Special Pay/Appointment Action 552-0125
Signature Authorization Form 552-0109
Agreement for Recouping Education Payments 552-0707
Pre-Audit
Excel Calculators (for calculating vacation and sick leave payouts, dates, pay adjustments, pay increases, and more)
Pre-Audit Calculators (protected)
Pre-Audit Calculators (unprotected)
Pay Period Calendars
2017 Pay Period Calendar
2018 Pay Period Calendar
2019 Pay Period Calendar
2020 Pay Period Calendar
Step Increase Date Schedules
Step Increase Schedule FY17
Step Increase Schedule FY18
Step Increase Schedule FY19
Presentations from HRA Trainings
2017 HRA Training Presentation 08-23-17
2015 PA Training Powerpoint - Excel Calculators
Employees Moving To/From Executive Branch and...
Department of Transportation
Regents Institution
Judicial Branch, Legislative Branch, or Community Based Corrections
Additional Resources (cheat sheets, checklists, and more)
P1 and M5 Types and Approval Levels
Appeal Board Claim Process
Applicant Tracking System Requirements for P1 Approval
Calculations for Pay Adjustments/Term leave Pay
Checklist - Terminations
Checklist - Regular Retirements (Non-SLIP)
Dates Cheat Sheet
Donated Leave Forms & Deduction Information
Documentation Required for Pre-Audit
Email Subject Line
Helpful Links
HRIS Cheat Sheet
HRIS – Table of Codes
Leave Code Chart and Definitions
Payroll Processing Times Calendar
Postal Service Abbreviations
Reemployment vs. Reinstatement
Transfer vs. Reassignment
Termination Code Guidance
When to Process an M5 or a P1
P-1 Type Descriptions (sorted by P-1 number)
005 Full-time Appointment – New Hire
015 Part-time Appointment – New Hire
025 Commission/Board Member New Hire
039 Temporary Type Appointment – New Hire
055 Transfer to SLIP
064 Board Member Reemployment
069 Reemployment
080-081 AmeriCorps > Temp Appt / Temp Appt > AmeriCorps
086 Temporary Appointment to Permanent Position
088 Lateral Transfer within Agency or Inter-Agency Transfer
099 Reinstate from Outplacement
099 Reinstatement
219 Home Address/Home Phone Change
239 Tax Status Change
249 Automatic Deposit Change
300 Taxable Fringe Benefit
304 Credit Union Deduction Change
400 Types Terminations
402 Retirement
470-475 SLIP Calculation
501 Leave of Absence
502 Leave Code Correction
620 Merit Increase
636 Pay Increase Due for Past Pay Period
677 Reassignment in Lieu of Layoff (Outplacement)
839 Health Insurance Opt-Out Correction
844 Move Pay/ Income Not Subject to Retirement/ Workers Comp Pay
845 Catastrophic Leave/ Other Pay Adjustment/ Term Leave Pay/ Sick Leave Pay (Legislative and Judical branches only)
846 Catastrophic Leave/ Other Pay Adjustment/ Term Leave Pay/ Sick Leave Pay
849 Settlement Pay
Reasonable Accommodation
Request for Reasonable Accommodation 552-0574
Relocation
Agreement for Recouping Payments 552-0751
Calculation of Mortgage Interest Differential 552-0703
Calculation of Market Value Differential 552-0704
Calculation of Income Tax Assistance Payment 552-0705
IRS Tests for Preparing Relocation Expense Claims 552-0706
Statement of Ownership of Principal Residence 552-0668
Moving Company Bid Sheet 552-0702
Relocation Expenses Recap (sample)
Travel Payment for Relocation Expenses (sample)
Travel Payment for Relocation Subsistence (sample)
Severe Weather Information
Severe Weather Policy
Severe Weather FAQ
Severe Weather Request for Assistance form
Sexual Harassment
Sexual Harassment Policy for Executive Branch Employees
Sick Leave Insurance Program (SLIP)
Sick Leave Insurance Program Enrollment 552-0713
Sick Leave Insurance Program Calculation Worksheet (for estimates only)
Sick Leave Insurance Program Checklist for Human Resources Associates
State Human Resource Policies
This section lists the more frequently accessed policies of DAS-HRE and Iowa state government.
Equal Opportunity, Affirmative Action and Anti-Discrimination Policy
State of Iowa Employee Handbook
Employee Assistance Program Policy
FMLA State of Iowa Policy
Substance Abuse
Substance Abuse Policy Guidelines for Supervisors
Relocation
Violence Free Workplace Policy
Employee Complaint Form (fillable)
Steps in the Hiring Process 552-0492
Taxable Benefits Processing
Taxable Benefits (P1 Type 300-301) Processing on HRIS
Telework
Telework Application
Telework Agreement
Telework Status Report
Temporary Services
Temporary Staffing Services Vendor Request 552-0647
Temporary Staffing Information
Workers' Compensation
Workers' Comp Benefit Election Form
Workers' Compensation First Report of Injury or Illness
Workers’ Compensation Provider List
Updated 11/20/2018