• This Disposition Table delineates known change histories of UT Arlington Fiscal, HR, and Campus Operations Exhibits.
  • Status information is the current status of each exhibit.
  • The date is an estimate of when the events shown in the Status column occurred.
  • Some Exhibit Numbers were reused by re-issuing the number of a discontinued exhibit to a later new exhibit.

By default, columns are sorted by record Index. You may change the sort order of the table by Index, Title, Status or Date by clicking on the table headings.

For questions or corrections, contact UT Arlington Net Solutions at netsolutions@uta.edu.

Index Title Status Date
1-1Departmental Payroll VoucherPublished01 Jan 1999
1-1Budget - Budget Request for Fiscal YearDiscontinued01 Nov 1993
1-2Check Distribution & Change of AddressPublished01 Jan 1999
1-2Budget - Fiscal Year 1993 Budget Planning Justifications FormsDiscontinued01 Nov 1993
1-3Earnings StatementDiscontinued24 Sep 2008
1-3Budget - Annual Income Budget ProjectionsDiscontinued01 Nov 1993
1-3ABudget - Annual Budget Request for Student Service Fee AllocationsDiscontinued01 Nov 1993
1-4W-5 Earned Income Credit Advance Pay CertificateExternal23 Mar 2006
1-41998 Form W-5Discontinued01 Jan 1999
1-4Budget - Monthly Budget ListingDiscontinued01 Nov 1993
1-5Budget - Request for Budget ChangeDiscontinued01 Nov 1993
1-6Departmental Vacation/Holiday Payroll VoucherPublished01 Jan 1999
1-6Budget - Summer Session Budget Planning DocumentDiscontinued01 Nov 1993
1-6.1Budget - Blanket Request ReappointmentsDiscontinued01 Nov 1993
1-7Salary Spread RequestPublished01 Jan 1999
1-8Authorization for Professional ServicesPublished01 Jan 1999
1-9Payee Information FormPublished01 Jan 1999
1-10Visa Waiver CountriesDiscontinued24 Sep 2008
1-11W-7 Application for IRS Individual Taxpayer Identification NumberDiscontinued30 Sep 2008
1-12Countries with Tax TreatiesDiscontinued24 Sep 2008
1-13IRS 8233 FormDiscontinued24 Sep 2008
1-14Payment Request Form - Nonresident Alien Employees/StudentsDiscontinued24 Sep 2008
1-17GLACIER Password - Nonresident Alien Tax SoftwareNot Published06 Sep 2007
1-18Request for Taxpayer Identification Number and CertificaitonPublished07 Jun 2005
1-19W-4 Employee's Withholding Allowance CertificateExternal23 Mar 2006
1-20W-9 Request for Taxpayer Identification Number and CertificationDiscontinued30 Sep 2008
1-21SS-5 Application for Social Security Card (Original/Replacement/Name Change)Discontinued30 Sep 2008
1-22TRS Web Site Password AuthorizationDiscontinued30 Sep 2008
2-1Account Profile and Request for New AccountPublished01 Oct 1991
2-2Custodian and Working Fund AuthorizationPublished01 Oct 2004
2-2Departmental Appropriation LedgerDiscontinued01 Oct 1991
2-3Official Occasion Expense FormDiscontinued20 Sep 2007
2-3Inter-Department Transfer FormDiscontinued15 Nov 1984
2-4Check Distribution and Change of AddressDiscontinued06 May 2008
2-4Request for Student Organization University AccountDiscontinued01 Oct 1991
2-5Texas Sales and Use Tax Exemption CertificationPublished16 Nov 2004
2-5Gift AdviceDiscontinued01 Oct 1991
2-6Payment Approval VoucherPublished08 Dec 2004
2-6Supplies InventoryDiscontinued01 Oct 1991
2-7Departmental DepositPublished08 Dec 2004
2-7Summary - Inventory of Supplies and Materials for ResaleDiscontinued01 Oct 1991
2-8Restrictive Payee StampPublished08 Dec 2004
2-8Request to Purchase - Grants OnlyDiscontinued01 Oct 1991
2-9Restrictive Endorsement StampPublished08 Dec 2004
2-9Payment Approval Voucher - Grants OnlyDiscontinued01 Oct 1991
2-10Daily Check LogPublished08 Dec 2004
2-10Departmental Transfer - Grants OnlyDiscontinued15 Nov 1984
2-11Cash ReceiptPublished08 Dec 2004
2-11Personnel Activity ReportDiscontinued01 Oct 1991
2-12Statement of Accounts Reconciliation & AcknowledgmentPublished08 Dec 2004
2-12Payment Approval Voucher (Instructions and Form)Discontinued31 Aug 1993
2-13Direct Deposit Form for StudentsPublished08 Nov 2005
2-13Request for Governor's Approval for State Employees Traveling to Foreign CountriesDiscontinued31 Aug 1989
2-14Custodian & Working Fund AuthorizationDiscontinued01 Oct 1991
2-15Restrictive Payee StampDiscontinued01 Nov 1993
2-16Restrictive Endorsement StampDiscontinued01 Nov 1993
2-17Copy of a CheckDiscontinued01 Nov 1993
2-18Official Restrictive Endorsement StampDiscontinued01 Nov 1993
2-19Texas Driver's LicenseDiscontinued01 Oct 1991
2-20Student and Faculty/Staff Identification CardsDiscontinued01 Oct 1991
2-21Daily Check LogDiscontinued15 Nov 1984
2-22Administrative SummonsDiscontinued31 Aug 1986
2-23Tuition Adjustment FormDiscontinued01 Nov 1993
2-24Department Deposit SlipDiscontinued31 Aug 1990
2-25Student Organization Payment Approval VoucherDiscontinued01 Oct 1991
2-26Justification and Pro Forma BudgetPublished18 Jun 2007
2-30Account Authorization Request Form & InstructionsPublished07 Mar 2005
2-31Dean-VP Routing Form & InstructionsPublished07 Mar 2005
2-32*DEFINE User Setup & Instructions (Individual)Published07 Mar 2005
2-33Department Office Setup & Instructions (Entire Department)Discontinued19 Mar 2008
2-34Electronic Signature Authorization Request & InstructionsPublished07 Mar 2005
2-44Asset Mgt - Certificate of Physical Inventory of EquipmentDiscontinued01 Oct 1991
2-45Asset Mgt - Inventory Transaction FormPublished01 Oct 1991
2-46Asset Mgt - Equipment Purchase NoticeDiscontinued01 Oct 1991
2-47Asset Mgt - Removal of Equipment from University CampusPublished01 Oct 1991
2-48Central Receiving Work Request FormPublished10 Dec 2004
2-48Asset Mgt - UTA Building AbbreviationsDiscontinued01 Oct 1991
2-49Asset Information FormPublished16 Nov 2004
2-49Asset Mgt - Tips on Taking Annual InventoryDiscontinued01 Oct 1991
2-50Document Destruction Request FormPublished15 Jun 2007
2-50Asset Mgt - Inventory of Supplies and Materials for ResaleDiscontinued01 Oct 1991
2-51Asset Mgt - Daily Report of Use of State-Owned Motor VehicleDiscontinued01 Oct 1991
2-60Application for Nurse Faculty ExemptionPublished08 Mar 2006
2-61Application for Preceptor ExemptionPublished08 Mar 2006
2-62Nurse Faculty Loan FormPublished22 Dec 2004
2-63Perkins Loan Repayment FormPublished22 Dec 2004
2-64Post Census Tuition Adjustment RequestDiscontinued06 May 2008
2-90Check Distribution & Change of AddressDiscontinued06 May 2008
2-91Request for Travel AuthorizationPublished08 Dec 2004
2-92Travel VoucherPublished08 Dec 2004
2-93Travel Advance VoucherPublished08 Dec 2004
2-94Texas Sales and Use Tax Exemption CertificationPublished08 Dec 2004
2-95Texas Hotel Occupancy Tax Exemption CertificateExternal08 Dec 2004
2-96Metroplex Mileage Detailed ReportPublished08 Dec 2004
2-97Travel Voucher Cover Sheet for Multiple AcctsPublished08 Dec 2004
2-98Official Occasion Expense FormPublished08 Dec 2004
2-99Official Occasions-Entertainment Exp (Memo)Published20 Aug 1996
2-100Travel Voucher Cover SheetPublished08 Dec 2004
2-101JPMorgan Chase Travel Cardholder AcctPublished08 Dec 2004
2-245Release of All ClaimsDiscontinued01 Oct 1991
3-1Employee Requisition FormDiscontinued01 Nov 1993
3-2Position Audit QuestionnaireDiscontinued01 Nov 1993
3-3Personnel Action FormPublished30 Mar 2005
3-3Personnel Transaction Form ( PO-1 )Discontinued01 Nov 1993
3-4Recruitment Summary for Classified PositionsDiscontinued01 Nov 1993
3-5Record of FLSA (Overtime) Compensation Time Earned and TakenPublished11 Nov 2004
3-5Personnel Appointment Summary FormDiscontinued01 Nov 1993
3-6Immigration Reform and Control Act of 1986 Required DocumentsDiscontinued01 Nov 1993
3-7Employment Eligibility Verification ( Form I-9 )Published06 Dec 2004
3-8Notice of Voluntary ServicePublished30 Mar 2005
3-8Personnel Termination Form ( PO-2 )Discontinued01 Nov 1993
3-9Criminal Background CheckPublished10 Nov 2004
3-9Employer's First Report of Injury or Illness ( TWCC-1, 2-91 )Discontinued01 Nov 1993
3-10Supplemental Report of Injury ( TWCC-6, 7-93)Discontinued01 Nov 1993
3-11Request for Paid Leave Due to On-The-Job Injury (WCI Form 23)Discontinued01 Nov 1993
3-11AEmployer's Wage Statement ( TWCC Form 3 )Discontinued01 Nov 1993
3-12Performance Review FormDiscontinued01 Mar 2009
3-12Performance Review FormPublished15 Sep 1987
3-13Employee Separation FormPublished31 Aug 1991
3-14Employee GrievancePublished31 Aug 1990
3-14AEmployee Grievance AppealPublished31 Aug 1990
3-15Appeal of Disciplinary ActionPublished31 Aug 1990
3-15AAppeal of Disciplinary Action ContinuationPublished31 Aug 1990
3-16Employee Check-Out ProcedureDiscontinued15 Sep 1987
3-16AEmployee Clearance Form - Electronic Notification (PC Version)Published06 Dec 2004
3-16BEmployee Clearance Form - Electronic Notification (Mac Version)Published06 Dec 2004
3-17Sick Leave Pool ContributionDiscontinued01 Nov 1993
3-18Sick Leave Pool ApplicationPublished31 Aug 1992
3-18AStatement of Attending PhysicianDiscontinued01 Nov 1993
3-19Outside EmploymentPublished30 Mar 2005
3-20Driving Record ReleaseDiscontinued01 Nov 1993
3-21Authorized DriversDiscontinued01 Nov 1993
3-22Driver HistoryDiscontinued01 Nov 1993
3-23Family Medical Leave ApplicationPublished01 Nov 1993
3-23Affidavit of Dependency Tuition Adjustment QualificationDiscontinued01 Nov 1993
3-24Certification of Physician or PractitionerDiscontinued01 Nov 1993
3-25Your Rights under the Family & Medical Leave Act of 1993Discontinued01 Nov 1993
3-27ANew Employee PaperworkPublished17 Jul 2007
3-27BInstructions for Employee PacketPublished17 Jul 2007
3-28Employee Insurance Enrollment ApplicationPublished10 Jul 2007
3-29Retiree Insurance Enrollment ApplicationPublished10 Jul 2007
3-30Benefits Cost WorksheetExternal10 Jul 2007
3-31Dependent Enrollment and Status Change FormPublished10 Jul 2007
3-32UTFLEX Enrollment FormPublished10 Jul 2007
3-33Coverage for Incapacitated Child FormExternal10 Jul 2007
3-34Medco Pharmacy Home Delivery Order Form (UT Select)External10 Jul 2007
3-35Medco Prescription Drug Claim Form (UT Select)External10 Jul 2007
3-36Transitional Benefits FormExternal10 Jul 2007
3-37UT Select Dental Claim FormExternal10 Jul 2007
3-38Superior Vision Provider NominationExternal10 Jul 2007
3-39UT FLEX Claim FormExternal10 Jul 2007
3-40UT FLEX Direct Deposit FormExternal10 Jul 2007
3-41UTFlex Letter of Medical NecessityExternal10 Jul 2007
3-42Fort Dearborn Term Life Beneficiary DesignationExternal10 Jul 2007
3-43Optional Retirement Program (ORP) Retirement Certification FormDiscontinued18 Mar 2008
3-44Notice of Creditable Coverage for Medicare Part DExternal10 Jul 2007
3-45TRS Form 6 (Notice of Final Deposit and Request for Refund)External10 Jul 2007
3-46TRS Form 18 (Request for Estimate of Retirement Benefits)External10 Jul 2007
3-47Transfer Verification FormExternal10 Jul 2007
3-48TRS Form 28 (Notice to Elect to Participate in Optional Retirement Program)External10 Jul 2007
3-49TRS Form 29 (Application for Refund)External10 Jul 2007
3-50Authorization for Reduction for Employee ContributionsExternal10 Jul 2007
3-51Authorization for Reduction for Employee Contributions for Employees returning to ORPExternal10 Jul 2007
3-52ORP Acknowledgement FormExternal10 Jul 2007
3-53Optional Retirement Program (ORP) Retirement Certification FormExternal10 Jul 2007
3-54Tax-Sheltered Annuity DisclosureExternal10 Jul 2007
3-55Purchase Change AgreementExternal10 Jul 2007
3-56Special Catch-Up Provision DisclosureExternal10 Jul 2007
3-57Short Term Disability Frequently Asked QuestionsExternal10 Jul 2007
3-58Long Term Care BrochureExternal10 Jul 2007
3-59COBRA Continuation NoticePublished10 Jul 2007
3-60HIPAA Privacy InformationExternal10 Jul 2007
3-61Accidental Death and Dismemberment Benefits GuideExternal10 Jul 2007
3-62Assurant Dental HMO Benefits GuideExternal10 Jul 2007
3-63UT System Group Benefit Handbook for EmployeesExternal10 Jul 2007
3-64Group Term Life Benefits GuideExternal10 Jul 2007
3-65Employee Discount Program Participation AgreementDiscontinued20 Aug 2009
3-65Employee Discount Program Participation AgreementPublished10 Apr 2008
3-66Long Term Disability Benefits GuideExternal10 Jul 2007
3-67Short Term Disability Benefits GuideExternal10 Jul 2007
3-68Superior Vision Benefits GuideExternal10 Jul 2007
3-69Teachers Retirement System (TRS) HandbookExternal10 Jul 2007
3-70UT FLEX Benefits GuideExternal10 Jul 2007
3-71UT Select Benefits GuideExternal10 Jul 2007
3-72UT Select Dental Benefits GuideExternal10 Jul 2007
3-73UT System Group Benefits Handbook for RetireesExternal10 Jul 2007
3-74UT System Retirement Programs GuideExternal10 Jul 2007
3-76Quest Release Time FormPublished10 May 2008
3-77Employee Tuition Certification FormPublished24 Jul 2008
3-84Sample Reference Check FormPublished23 Mar 2009
3-85On-Campus Summer Camp / Conference Employment ApplicationPublished01 Apr 2009
3-201Personal Information FormPublished16 Jul 2007
3-202State Employment Verification FormPublished04 Mar 2008
3-203Selective Service Registration Verification FormPublished04 Mar 2008
3-204Sick Leave Pool Contribution FormPublished11 Nov 2009
4-1Request to Purchase - Standard RequestPublished31 Aug 1999
4-2Request to Purchase - Split AccountsPublished31 Aug 1999
4-3Request to Purchase - Confirmation RequestPublished31 Aug 1999
4-4Purchasing Card Reconciliation Log and ExamplePublished31 Aug 1999
4-5Purchasing Card Transaction Log and ExamplePublished31 Aug 1999
4-6Asset Information FormDiscontinued06 May 2008
4-7Statement of Disputed Item Form ( ProCard)Discontinued31 Aug 1999
4-8Purchasing Card ApplicationPublished31 Aug 1999
4-9Wireless Communication Device Allowance RequestPublished08 Jun 2004
4-9Tax Exemption CertificateDiscontinued31 Aug 1999
4-10Vendor Performance FormPublished31 Aug 1999
4-11Cardholder AgreementPublished31 Aug 1999
4-12Major Consulting Services Contract Approval RequestPublished18 Nov 2004
4-12Letter of Written Justification for a Single Source ProcurementDiscontinued31 Aug 1999
4-13Emergency JustificationPublished30 Nov 2001
4-14Sole-Source/Proprietary Justification For ServicesPublished30 Nov 2001
4-15Sole-Source/Proprietary Justification For GoodsPublished30 Nov 2001
4-16Gift Certificate Expense FormPublished14 Jun 2007
4-17Comdata Corporation Dispute Processing FormPublished18 Jul 2007
4-18Summus/Staples ApplicationPublished18 Jun 2007
5-1Notice to Department - Automotive Preventative Maintenance ScheduleDiscontinued31 Aug 1999
5-22nd Notice to Department - Automotive Preventative Maintenance ScheduleDiscontinued31 Aug 1999
5-3Sample Interdepartmental Transfer for Vehicle RepairDiscontinued31 Aug 1999
5-4Vehicle Request FormPublished08 Dec 2004
5-5Operation of UTA 15-Passenger VansPublished08 Dec 2004
6-1GTA Parking Permit Decal PermissionPublished25 Jul 2006
6-1Key Return/ReceiptDiscontinued31 Aug 1999
6-2Special Parking Permit/Salary VerificationDiscontinued15 Jun 2007
6-2Key Control Department/Payment for Lost KeysDiscontinued31 Aug 1999
6-3Key Request Issuance and ReceiptDiscontinued31 Aug 1999
8-1Instructions for Employers First Report of Injury or IllnessDiscontinued01 Jun 2000
8-2Supervisor's Report of Employee Work-Related Injury or Occupational DiseasePublished24 Oct 2007
8-2Employers First Report of Injury or IllnessDiscontinued01 Jun 2000
8-3Supplemental Report of InjuryExternal24 Jun 2008
8-3Supplemental Report of InjuryDiscontinued28 Feb 2008
8-3Instructions for TWCC-6 (Supplemental Report of Injury)Discontinued01 Jun 2000
8-3ASupplemental Report of InjuryDiscontinued01 Jun 2000
8-4Request for Paid Leave Due to On-The-Job InjuryPublished01 Jun 2000
8-5Employer's Wage StatementDiscontinued28 Feb 2008
8-6Employee's Report of Work-Related Injury or Occupational DiseasePublished01 Jun 2000
8-7Detailed Description of Injury/Illness and Accident SceneDiscontinued02 Nov 2007
8-8Modified Work Duty AgreementDiscontinued01 Jun 2000
8-9Notification of Work-Related InjuryPublished08 Dec 2004
8-9Return to Work CertificationDiscontinued01 Jun 2000
8-10Injured Employee Workers Compensation GuidelinesPublished14 Apr 2005
8-11Supervisor's Workers Compensation ChecklistPublished14 Apr 2005
8-12Workers Compensation Injury Witness StatementPublished21 Feb 2005
8-13Ergonomic Evaluation RequestPublished10 Aug 2006
8-14HSI Rx First Fill Pharmacy CardDiscontinued01 Sep 2009
8-14Bridgeway First Fill Pharmacy CardPublished30 Jan 2008
8-15Work Status Report and InstructionsExternal28 Feb 2008
8-16Workers Compensation Insurance Employee Request for Reimbursement of Medical ExpensesPublished24 Jun 2008
8-17Employee's Claim for Compensation for a Work-Related Injury or Occupational DiseaseExternal24 Jun 2008
8-18Notice of Fatal Injury or Occupational Disease and Claim for Compensation for Death Benefits External24 Jun 2008
8-19Employee's Request to Change Treating Doctor - Non Network External24 Jun 2008
8-26Biosafety Lab Evaluation FormPublished01 Aug 2005
8-27Survey of Biological Agents FormDiscontinued06 Nov 2009
8-27Survey of Biological Agents FormPublished01 Aug 2005
8-28Request for Disposal Form - Biological Waste and SharpsPublished01 Aug 2005
8-29Hepatitis B Vaccine WaiverPublished21 May 2008
8-30Human Pathogen Registration DocumentPublished21 May 2008
8-31Human Pathogen Registration UpdatePublished21 May 2008
8-36Laboratory Safety Evaluation ChecklistPublished09 Sep 2005
8-37Request for Disposal - Hazardous ChemicalsPublished09 Sep 2005
8-46UTA Hazard Reporting FormPublished05 Oct 2005
8-56Application for Copy of Driver RecordPublished10 Aug 2005
8-61UTA Hot Work PermitPublished08 Sep 2005
8-66Lockout/Tagout Authorized Employee Training FormPublished13 Mar 2006
8-67Lockout/Tagout Request FormPublished13 Mar 2006
8-68Lockout/Tagout Master Index FormPublished13 Mar 2006
8-69Lockout/Tagout Periodic Inspection FormPublished13 Mar 2006
8-70First Aid Kit Supply Request FormPublished13 Mar 2006
8-71IAQ Occupant Interview FormPublished13 Mar 2006
8-72Student Visitor Injury-Illness FormPublished18 Oct 2007
8-81Application to Use Radioactive MaterialsPublished17 Aug 2005
8-82Request for Radiation Dosimeter FormPublished17 Aug 2005
8-83Request to Purchase Radioactive Materials FormPublished18 Aug 2005
8-84ARadiation Safety Evaluation - Radioactive MaterialsPublished18 Aug 2005
8-84BRadiation Safety Evaluation - X-Ray Producing MachinesPublished18 Aug 2005
8-84CRadiation Safety Evaluation - LasersPublished18 Aug 2005
8-85Pregnancy DeclarationPublished15 Feb 2008
8-86Pregnancy Declaration WithdrawalPublished15 Feb 2008
8-87Biosafety Level 2 (BSL-2) Commissioning ChecklistPublished09 Feb 2009
8-88Laser Registration FormPublished10 Mar 2009
9-1Description of a Large System Development ProjectDiscontinued31 Aug 1990
9-2Request for Administrative Information Systems ServicesDiscontinued31 Aug 1990
9-3Computer Configuration in Administrative Information SystemsDiscontinued31 Aug 1990
11-1Paper Order FormPublished08 Dec 2004
11-1Printing Trade CustomsDiscontinued31 Aug 1984
11-2Forms Order RequestPublished08 Dec 2004
11-2Printing Order FormDiscontinued31 Aug 1984
11-3Print Order FormPublished08 Dec 2004
11-5Print Proof FormDiscontinued06 May 2008
13-1Faculty and Staff Organization Registration FormPublished08 Dec 2004
13-1Affidavit for Faculty and Staff OrganizationsDiscontinued01 Oct 1991
13-2Records Retention LogDiscontinued04 Feb 2009
13-2Records Retention LogPublished08 Dec 2004
13-2Faculty and Staff Organization Registration FormDiscontinued01 Oct 1991
13-3Request for Authority to Dispose of State RecordsPublished08 Dec 2004
13-4Fiscal Procedure Exhibit TemplatePublished26 Oct 2007
13-6Records Disposition LogPublished04 Feb 2009
13-7Request for Authority to Dispose of Unscheduled University RecordsPublished04 Feb 2009
13-9Preliminary Summary Report of Tort Claims and Possible Tort ClaimsPublished25 Aug 2009
15-1Summer Conference Statement on InsurancePublished27 Mar 2005
15-2Summer Conference Admission Presentation Request FormPublished27 Mar 2005
15-3Summer Conference Access Card & Hang Tag FormDiscontinued06 May 2008
15-4Summer Conference Housing Reservation FormPublished27 Mar 2005
15-5Summer Conference Dining Reservation FormPublished27 Mar 2005
15-6Summer Conference E.H. Hereford University Center Facility Reservation FormPublished27 Mar 2005
15-7Summer Conference Activities Building Rental ApplicationPublished27 Mar 2005
15-8Summer Conference Texas Hall Reservation RequestDiscontinued06 May 2008
15-9Summer Conference Housing Equipment Issuance AuthorizationPublished27 May 2008
15-10Alcoholic Beverage Request FormPublished04 Dec 2008
20-1UTA Gift Records FormPublished08 Dec 2004
20-2UTA Payroll Gift Deduction FormPublished07 Jun 2005
21-1Request for Disbursement of Scholarship / Fellowship AwardPublished16 Dec 2005
22-4Departmental Request to Initiate Legal Permanent ResidentPublished23 Jul 2009