Relocation Form - Human Resources



UNIVERSITY OF PENNSYLVANIA REQUEST FOR RELOCATION SERVICES Page 1 of 2 Date: _____/_____/______Form must be submitted electronically from Penn’s HR website or as email attachment to Whalen’s AlliedChris Scheu, CMC, MAT Phone: 800-759-4253 ext.240 Email: cscheu@From (Authorized Hiring Officer): _______________________________________________________Phone: ______________________________ Email: __________________________________________Penn Dept. ____________________________________________________________________________New Faculty/Staff name (and Spouse/Partner if applicable) Last 4 SS# __ __ __ __ (required by Penn)_____________________________________________________________________________________Penn Title: ___________________________________________________________________________Current address: ____________________________________________________________________ ____________________________________________________________________Own _________ or Rent _________Home Phone: _________________________ Office Phone: ___________________________________Cell Phone: __________________________ Email: __________________________________________Approximate move date: _______________________________________________________________Additional materials from office/lab or another location Yes _______No _______Location (if known) ___________________________________________________________________Any additional pertinent information:Services Authorized for ___________________________________________________Must be completed by an Authorized Hiring Officer and submitted electronically to Whalen’s Allied either through the Penn HR website or as an email attachment to cscheu@ Check DesiredBenefits/ServicesServices below are NON-TAXABLE (to qualified employees) if the relocation is over 50 miles from the old to new residence and incur NO MANAGEMENT FEE Hiring Department must issue a PO to Whalen’s Allied after the estimate is performed*? Full Service Household Goods Move: containers, packing, moving, unpacking and appliance servicing. Please note any dollar limit or service exceptions that must be paid by the employee. $ _______________________?Storage (if needed) up to 30 days or $ ________? Bulky items (note #) Piano ____Auto ____ Boat ____ XL TV ____Extra stops (please note #) ______? Home Sale Assistance – Nationwide Preferred Broker Network (no cost – cash back rewards) for more information visit ? Home Purchase Assistance- (no cost – cash back rewards) for more information visit Assistance – (no cost – closing allowance reward) for more information * Services below may be TAXABLE ITEMS to the employee. Per Penn policy, they must be administered through Sirva’s Tax Computation Accounting Service if Penn is paying for these benefits. For more information on taxability issues go to Hiring Department must issue PO to Sirva Relocation if authorizing services below*Tax computation Service (includes employee year-end relocation benefits tax liability report) $500 accounting service fee applies (in addition to relocation allowance specified to the new hire)Rental Assist (tour, schedule and view properties, lease sign assist) $650 Gross up___**? Household Goods Storage after 30 days up to ___ days or $______ limit Gross up___*Per Penn policy, benefits below must be administered through Sirva’s Expense Management Accounting Service. XXXXXXXXXXExpense Management Service – relocation expenses reimbursed directly to employee and included on invoice/report - $700 additional accounting service fee applies (in addition to relocation allowance specified to the new hire) ? House hunting (meal, lodging & travel) # trips ___ up to $ __________ Gross up___**Spouse/Partner Career Counseling up to $________________ Gross up___** Temporary Living up to ______ days or $ ___________ limit Gross up___*Final move travel expenses (meals, lodging & travel) up to $ _________ Gross up___***Purchase Orders should be issued as a service line order and include the following verbiage: Service Line Order - Exact pricing and services are undetermined and/or ongoing. Include anticipated maximum allowance dollar amount. **Gross up = Penn to compensate employee for income tax liability on taxable relocation benefits ................
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