NAME AND SOCIAL SECURITY NUMBER (SSN) CHANGE FORM
For employees who need to correct an incorrect SSN
or submit a name change, this form should be completed by the appropriate
representative in the employee’s home department and submitted to the Campus
Human Resources Office. For undergraduate student employees, the form should be
submitted to the Student Employment Office.
For employees who need to change from a TCN to an
SSN, this form should be completed by the appropriate representative in the
employee’s home department and submitted to the Campus Human Resources
Office. Undergraduate student employees
should submit the form to the Student Employment Office. A copy of this form
and photo copied documentation (i.e. SSN card), should be submitted to the
appropriate International Office. The home department should also retain a copy
of this form and documentation.
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Contact Information |
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Name of Representative Submitting Request: |
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Department of Representative Submitting Request: |
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Contact Email: |
Request Date: |
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Contact Phone Number: |
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SSN and Name Change Information |
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Name
of employee requiring change:
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UIN of employee requiring change: |
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Existing
Temporary Control Number (TCN) or Incorrect SSN*:
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New
or Correct SSN*:
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Reason
for Change:
Change from TCN to
SSN
SSN was
incorrect/changed Name Change |
Previous Name: |
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Name changed to: |
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Required Documentation:
(Please photocopy documentation and attach to this form.)
1. SSN Card issued by the Social Security Administration 2. Government Issued Photo ID (SSN change only) |
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Authorizing
Signature
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Signature of home department representative who is authorizing this change:
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Department:
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Date:
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Office |
University of Illinois at Chicago |
University of Illinois at Springfield |
University of Illinois at Urbana-Champaign |
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Human Resources |
Human Resources, 401 HRB 715 S. Wood, MC-897 Chicago, IL 60612
Phone
312-413-3490 Fax
312-996-1803 |
Human Resources, HRB 30 One University Plaza Springfield, IL 62703-5407 Phone 217-206-7078 Fax 217-206-7145 |
(Civil Service Employees) Personnel Services Office 52 E. Gregory, MC-562 Champaign, IL 61820
Phone 217-333-3101 Fax 217-244-7304 |
(Academic Employees) Academic Human Resources 807 S. Wright St. Suite 420, MC-310 Champaign, IL 61820
Phone 217-244-2400 Fax 217-333-4019 |
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Student Employment |
Student Employment, 2200 SSB
1200 W. Harrison, MC-335 Chicago, IL 60612
Phone 312-996-3130 Fax 312-413-7944 |
Student Financial
Assistance,SAB 60 One University Plaza Springfield, IL 62703-5407 Phone 217-206-6724 Fax 217-206-7376 |
Student Employment 620 E. John, MC-303 Champaign, IL 61820
Phone 217-333-0600 Fax 217-244-6589 |
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*Federal
tax regulations require us to request an SSN from every employee to whom
compensation is paid. Employee SSNs are maintained
and used by the University for payroll and benefits
purposes, to verify employment history, and are reported to Federal and state
agencies on forms required by law or for benefits purposes. The University will
not disclose an employee's SSN without the consent of the employee to anyone
outside the University except as mandated by law or as required for benefit
purposes. Failure to provide an SSN may result in the withdrawal of an offer of
employment and/or the denial of benefits. The University of Illinois is working
to minimize the use of Social Security numbers within its business processes.
For a full description of the University of Illinois’ Social Security number
policy, please visit http://www.ssn.uillinois.edu
.