Retroactive Payment Request Form
Retroactive Payment Request Form
Retroactive Payments are defined as payments owed to an employee for time worked in a prior pay period (other than the one that is currently being processed). Please use this form to request payment for an OPS Hourly employee only. This form must be completed correctly and received in Human Resources by the posted deadline on the Payroll Calendar to allow Payroll Services sufficient time for processing (assuming that the employee record is active). *Please ensure that all necessary timesheets are attached to this request.
Employee's Name: _______________________ Employee ID: __________ Record #: ______
Group Number: _________ Funding Department: _________________________________
Reason for Request: _____________________________________________________________
______________________________________________________________________________
Pay Period Begin Date
Pay Period End Date
Total Number of Hours to be Paid
Hourly Rate of Pay
Total Amount for Pay Period
$
$
$
$
$
$
*The applicable signed timesheets should be attached to this form. Are timesheets attached? Yes (please verify and check the box)
Prepared By: ____________________________
(Please Print Your Name)
Telephone #: _______________________
Approved By: ___________________________
(Please Print Your Name)
Mailing Instructions: email to payroll@ucf.edu or send via secure fax to (407) 882-9026
Approved By: _____________________
(Signature)
For HR Payroll Use Only Signature: _______________________ Pay Period End Date: __________________
................
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