Payroll Adjustment Form - UMBC
|Payroll Adjustment Form |
|University of Maryland, Baltimore County |
This form should be used to submit payment adjustments for specific types of earnings that require authorization and/or verification by HR- Payroll.
|Employee Name | |Pay Period | |
|Empl ID/Record # | / |Service Dates | |
|Position # | |Payroll Contact | |
|Bi-weekly Salary | |Contact Phone | |
|Tax Period Segmentation | |Department ID/Name | |
|ADJUSTMENTS TO BENEFIT ELIGIBLE POSITIONS |
|Check |Type of Pay |Description |Earnings Code |Amount |Hours |
| |Regular Pay Adjustment |Retirement Eligible adjustment (Ex. retroactive |RAJ | |
| | |increase, new hire, contract payout for retirement | | |
| | |eligible earnings) | | |
|ADJUSTMENTS TO NON-BENEFIT ELIGIBLE POSITIONS |
|Check |Type of Pay |Description |Earnings Code |Amount |
| |Prior Pay Period |New hire/Pay not entered in Time Entry (Hrly or |REG | |
| |Adjustments |contingent employee) | | |
| |Adjustment to Regular Pay|Positive Adjustment to Pay (non-benefit eligible |ADJ | |
| | |position) ex. Summer, winter, flat pay | | |
|Description: |
Preparer: _______________________________ ___________________________ ______
Print Sign Date
Approver: _______________________________ ___________________________ ______
Print Sign Date
Payroll Use ONLY
| 000087 |Advance Recovery |$ |
| |
| |
|Payroll Authorization Date |
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