VCUHS VCUCard Policy - Student Advantage

Non-Employee Data Form page 2 9/00
Instructions for Completing Non-Employee Information (NEI) Form
Introduction
NEI forms must be completed and submitted by individuals designated as authorizing agents by their department
manager. For large groups, a spreadsheet containing the required fields may be submitted in lieu of individual
forms. NEI forms may be downloaded from the MCV BAS1 server shared drive in the HRForms folder.
General Information:
HR Fax number: 628-0014 VCUCard Fax number: 828-8855
HR Email Address: tstanley@mcvh-vcu.edu
VCUCard email address: VCUCard@aspen.vcu.edu
The NEI form is a two-page form. The second page is used as a checklist to indicate that all aspects of a student
affiliation have been completed prior to an ID being issued. Forms will be sent back to departments submitting
student data that have not completed this section (thus preventing the student ID from being issued.)
Departments should keep a copy of the NEI form on file in their area and submit the original to MCVH HR.
Instructions for Completing:
Reason for Submission: Indicate if the form is being submitted because this is a new non-employee role (first role)
for the individual (New), to change information previously submitted (Change), to notify HR of separation from a
role (Separation), or to notify VCUCard that a replacement ID is required (Replacement). If the reason is
“Replacement” send to VCUCard, not HR.
Category: Check all that apply for the individual if multiple roles are being identified.
Section A. Individual Data: Complete entire section for first time submissions. Name and SS# must be completed
for changes, separations or replacements in addition to other pertinent data for intended action.
Name: Individual’s last and first name and middle initial
SSN: Individual’s social security number
Address: Individual’s home address
Home Phone, Work phone: Individual’s home and work telephone number, include area code for home number.
Job Title/Role: Identity title for role they are to perform. Job titles must match MCVH job title designations.
Example for students: Nursing Student, Medical Student, etc. Contact HR if assistance is needed in identifying title
that should be entered.
Identification Verification:
Document Present: Check which form of documentation was used to identify individual.
Document Number: Usually social security number but may differ for passports or states other than Virginia.
State: The state should be completed if a driver’s license or state issued ID is used.
Emergency Contact, Phone: Who should be contacted in case of injury or medical emergency? (optional)
If contract staff, Employer’s name: Name and phone number of contractor/agency who actually pays individual.
If student, School or Affiliation: Name of the school or training facility/organization with whom this student is
affiliated. List your contact at that school and their phone number.
Will individual need supervisory access to TRS? Indicate if this person’s role will involve timekeeping
requirements and therefore access to TRS. HR will notify Payroll if checked yes.
Section B. Sponsoring Department Data
Sponsoring Department: Department name authorizing individual to be here. Example: hired the company to
provide staff services or agreed to provide educational experience to student.
Account Code: VCUCard charges departments to issue IDs to contractors. Enter the code you would use to pay this
charge.
MAS Code: MAS code of sponsoring department