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 sections for convenience:
Administrative Rules
The Department of Administrative Services' primary rule chapter is 11 of the Iowa Administrative Code.
Agency Human Resources Contacts
Benefits
- HRE Benefits website Benefits forms and other information can be accessed at this website.
- 2022-2023 Health and Dental Deduction Schedule
- 2023 Added-Value Tax Matrix
Coverage Beginning and Ending Dates
Health and Dental insurance Premiums
- 2023 Health and Dental Premium -All Employees (All employees except SPOC-covered employees)
- 2023 Health and Dental Premiums -SPOC-covered Employees
COBRA
- COBRA website
- COBRA Notification/Election form
- 2023 COBRA Premiums
- Health insurance application
- Delta Dental application
Flexible Spending Accounts
Retiree Health Insurance
- 2023 Retiree Premiums - Medicare Eligible
- 2023 Retirees - Non-Medicare Eligible
- Benefit videos
- Wellmark's Find a Provider
Leave Programs
Life Events
- Life Events website (updated 05/13/2020)
- Life Events Matrix
Life Insurance
- 2023 Life Insurance Premiums (All employees except SPOC-covered employees)
- 2023 Life Insurance Premiums for SPOC-covered Employees
- Waiver of Life And Long Term Disability Insurance
Updated 12/14/2021
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
- NEOGOV Resources
- NEOGOV Webinar
- 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:
Fiscal Year End Processing
- 2022 Fiscal Year-End Processing - Compensatory, Holiday, Family Care, and Other Balances
- FMLA 2022 Fiscal Year-End Information
Insurance Arrears and Adjustments
Arrears Forms
Health and Dental Forms
(Only to be used for exceptions and corrections that can no longer be done in the system)
- Trustee Report Adjustments (TRA) (M-005-04)
- State Share Transfer - Health & Dental (M-0335)
- Refund Form (M-0334)
- Transfer Between Carriers (M-0576) PDF
Life and LTD Forms
(Only to be used for exceptions and corrections that can no longer be done in the system)
- State Share Transfer - Life & LTD (M-005-01)
- Supplemental Life Payment (M-005-02)
- Refund Form (M-0334)
Training Materials
- Arrears Balance Collection for a Terminating Employee
- Training Slides - Manual Billing Adjustment Process
- Arrears Balance Collection for a Terminating Employee
HRA Helps and Example Letters
- Terminating Employee Check List for Arrears
- Example Letter Template: Bill for Outstanding Arrears Coming Soon
- Example Letter Template: Second Notice Bill for Outstanding Arrears Coming Soon
Internships
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
- HRA - Life Processing Steps Guide
- Life Insurance Claim Application (to be completed by agency)
- Beneficiary Statement (method of benefit payment)
- Beneficiary Life Claim Letter (example to be sent with beneficiary statement)
- Life Insurance Webpage
- True Portability And Conversion Frequently Asked Questions and Guidelines
Long Term Disability Insurance
- HRA - LTD Processing Steps Guide
- LTD Cover Letter for Employee (sample letter)
- LTD Employee and Physician Statement (to be completed by the employee)
- LTD Employers Statement (to be completed by the agency)
- LTD FAQs for Filing a Claim
- LTD Insurance webpage
Manuals and Other Resources
Military Leave
Forms:
- Military Leave Checklist for State of Iowa Employees
- Request for Military Leaves Dates
- State of Iowa Military Leave Performance/Increase
- Military Service - Voluntary Written Notice of Intent Not to Return
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
Pay Period Calendars
- 2020 Pay Period Calendar
- 2021 Pay Period Calendar
- 2022 Pay Period Calendar
- 2023 Pay Period Calendar
- 2024 Pay Period Calendar
Next Increase Date Schedules
(previously referred to as "Step" Increase Dates)
- Next Increase Date Schedule FY20
- Next Increase Date Schedule FY21
- Next Increase Date Schedule FY22
- Next Increase Date Schedule FY23
- Next Increase Date Schedule FY24
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)
- Appeal Board Claim Process
- Calculations for Pay Adjustments/Term leave Pay
- Checklist - Terminations
- Dates Cheat Sheet
- Documentation Required for Pre-Audit
- Email Subject Line
- Helpful Links
- HRIS Cheat Sheet
- HRIS – Table of Codes
- Postal Service Abbreviations
- Reemployment vs. Reinstatement
- Transfer vs. Reassignment
- Termination Type Guidance
P-1 Type Descriptions (sorted by P-1 number)
- 001 New Hire - Permanent Position
- 219 Home Address/Home Phone Change
- 402 Retirement
- 501 Leave of Absence
- 620 Merit Increase
- 636 Pay Increase Due for Past Pay Period
- 849 Settlement Pay
Reasonable Accommodation
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
- Travel Payment for Relocation Expenses
- Travel Payment for Relocation Subsistence
Questions? Send an email to Centralized Payroll
Retirement Checklists and Templates
- Non-SLIP Retirement Process Checklist
- SLIP Retirement Process Checklist
- Medicare Retirement Process Checklist
- Regular Retirement Exit Letter Template
- SLIP Retirement Exit Letter Template
- Medicare Retirement Exit Letter Template
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
- SLIP Retirement Exit Letter Template
- Medicare Retirement Exit Letter Template
Safety
- Ergonomic Office: Self-Assessment - Enroll through the Learnsoft LMS
- New Employee Safety Orientation video
- OSHA Recordkeeping Decision Tree
- OSHA 300, 300A Forms & Electronic Recordingkeeping Slides
Severe Weather Information
Sexual Harassment
State Human Resources 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
Telework
Temporary Services
Unemployment Insurance Management
Workers' Compensation
- Workers' Comp Benefit Election Form
- Workers' Compensation First Report of Injury or Illness
- Workers’ Compensation Provider List
Last updated 04/26/23