Forms, Form Letters & FAQs

Leave (Childcare)

• Childcare Leave:  Letter submitted to the District informing them of your pregnancy and requesting the use of sick time and/or up to a maximum of 2 years childcare leave.

• Childcare Extension:  Letter submitted to the District requesting an extension of your child care leave if the initial leave was less than 2 year.

• Childcare Rights:  A letter members receive from the VCTA upon receipt of a Childcare Leave letter detailing your rights and responsibilities.

• Childcare FAQs:  Questions and answers regarding childcare leave.

Health/Medical

• Health Plan Comparison Chart:  A side-by-side comparison regarding NYSHIP, OUSDHP, MVP, GHI and Empire HMO. Rates for OUSDHP change July 1st and rates for the other plans change January 1st of every year.

• Health Insurance Contribution Rates: Health contribution rates for active employees. Rates are provided for OUSDHP, NYSHIP, MVP (HMO), GHI (HMO) and EMPIRE (HMO).

• Health Insurance Buyback Form:  This form must be completed each year. If you chose to keep comparable health insurance coverage through your spouse this form will notify the District of your intention to receive the buyback compensation covered in Article XXV, Section C of the CBA.

• Health Insurance Comparability Checklist/Form :  ALWAYS CONSULT A UNION OFFICER BEFORE SUBMITTING THIS FORM!! This is a District form that provides a format to compare the OUSDHP to the health plan provided to your spouse for the purpose of determining buyout options.

• Dental & Optical Claim Forms: Go to the SIDS website for claim forms, a review of your itemized claim history and a look at the benefits booklet to determine coverage eligibility.

• AFLAC Claim Form:  This link takes you to the AFLAC (IRS 125 Plan) website's PDF claim form that may be use to request reimbursement for dependent childcare and unreimbursed medical expenses. Enrollment in the IRS 125 must take place by October 1st of each year to be eligible for reimbursements.

• Empire Medical Forms:  This link takes you to the Empire website where you can download useful medical forms, including their Medical Reimbursement/Claim Form.

• GHI Medical Forms:  This link takes you to the GHI website where you can download useful medical forms, including their Medical Reimbursement/Claim Form.

• MVP Medical Forms:  This link takes you to the MVP website where you can download useful medical forms, including their Medical Reimbursement/Claim Form.

• NYSHIP Enrollment Form: This link accesses a PDF NYSHIP Enrollment Form.

• OUSDHP Medical Forms: This link takes you to the Orange Ulster School Districts Health Plan website. Many forms are not available on this site; therefore, we have attempted to add necessary OUSDHP forms to this page and our Health Insurance page as well.

• OUSDHP Claim Form: This interactive claim form is required for each patient for whom a claim is made. Participants should NOT pay PPO Network Providers.

• OUSDHP Dependent Student Certification Form: Information is to be completed by the Registrar's Office of the college your dependent is attending. Failure to have this form will result in a delay of coverage for your dependent.

• OUSDHP Appeals Form: Use this form to appeal a denied claim with the OUSDHP. It is suggested that you contact Christina Howe at Central Office for assistance. Christina is the OUSDHP representative for Valley Central employees.

Retirement

• Moving From Payroll to Pension Deduction: This information offers contact numbers and a step-by-step process for transitioning between active member payroll deduction and retired member pension deduction.
• Retiree Preference Form:  This form specifies wheather a retiree wishes to receive the VC Echoes as a hard copy via regular mail or receive an email notice regarding when a new VC Echoes has been published on the web. Retirees are asked to provide a mailing address regardless of their Echoes delivery method for the purpose of generating a mailing list for the Annual Retiree Luncheon, etc.
• Retirement Letter:  Letter submitted to the District notifying the BOE of your retirement. This letter specifies the conditions of retirement, including effective date and benefits.
• Retirement Target Dates:  Target dates to remember in regards to retirement.
• Retiring with Benefits: Take these steps for a smooth transition to membership and pension deduction (NYSUT United, March 2011)

Auto & Home Insurance

• Auto Insurance Rate Quote Form:  VCTA members receive an extra 5.5% off Travelers Auto Insurance Rates. At the top of each form provide the following code to indicate your eligibility for a VCTA discount: OMI861. For more information view our Member Discounts & Savings page.

• Homeowner Insurance Rate Quote Form:  VCTA members receive an extra 7% off Travelers Homeowners Insurance Rates. At the top of each form provide the following code to indicate your eligibility for a VCTA discount: OMI861. For more information view our Member Discounts & Savings page.

Financial

• VCSD Business Office Forms:  Mileage & Expense Reimbursement; Mileage Chart; Petty Cash Form; Claim Form; Requisition Form; Budget Transfer Form

• VCSD Payroll Information & Health Insurance Forms:  Health Insurance Buyback Form; Payroll Dates; IRS Federal Withholding Tax Form (W-4); NYS Withholding Tax Form; 22 vs. 26 Pay Election Form; Direct Deposit Authorization Form; OUSDHP/INDECS Enrollment, Claim & Dependent Certification Forms; NYSHIP Application; OMNI 403b Form

• Check Stub Codes:  An itemized list of payroll deduction codes that appear on your check stub along with a description of what each code means.

• Direct Deposit Authorization Form:  This form authorizes the Valley Central School District each pay day to deposit your paycheck directly to your bank account. This authority will remain in force until the District is given written notification that you wish to stop direct deposit.

• Dues Calculations for 2010-2011:  VCTA, NYSUT and AFT Dues Calculated by Yearly Income

• OMNI 403b Flex Form:  This form must be completed to enable the common remitter (OMNI) to ensure IRS compliance with 403b investment payroll deductions.

• Surviving Spouse Checklist:  A checklist of "who to contact" and "what to do" with regard to pension, social security, veterans and health benefits, as well as payroll funds, life insurance policies, the probate process and tax considerations.

Miscellaneous

• APPR―Annual Performance Professional Review:  This document specifies how classroom observations (formative assessments), alternative assessments and end of year evaluations (summative evaluations) will be conducted.

• Committee Assignment Completion Form:  Submit this form to indicate completion of activities relevant to committee assignments. Mail the completed form to the union office.

• Echoes Adverting Contract:  Submit this form to advertise in our award winning newsletter.

• National Board Certification Resource Guide:  Link to the AFT's "A Guide to Understanding National Board Certification: 2008 Candidacy Cycle"

• New York State Teacher of the Year Application Form:  Nominate an outstanding teacher in your school for the 2008 New York State Teacher of the Year. Deadline for Applications is Friday, February 16, 2007.

• Nomination Form:  This VCTA elections form must be completed along with a biography and submitted to the Elections Chair to ensure eligibility to run for VCTA officer positions.

• Scholarship Application:  Application form for the Valley Central Teacher Association's annual scholarship. Applications are generally due in the month of May. If a specific due date is not listed on the Scholarship Winners page, call the Valley Central High School Guidance Department.

• School Calendar:  Current School Calendar

• VOTE-COPE Contribution Form:  Complete the "Contribution Card" portion of this form if you wish to make a direct contribution. Complete both "Payroll Deduction Authorization Card" portions of this form if you would like your contribution to be deducted from your paycheck. Return this form to your VOTE-COPE Coordinator, Robin Sinclair-Scott, at Berea Elementary School or directly to your union office.