Repayment Agreement-draft
Repayment Agreement
University of Michigan
I, _________________________, emplid ____________________ acknowledge a debt of $______________ owed to the University of Michigan. This debt is the result of salary overpayments, from ___________________ to ___________________.
Repayment Schedule
Repayment of the above overpayment will be made in accordance with the following schedule. Payroll deductions will be made on a pay cycle basis (biweekly or monthly) based on the information entered below:
Calendar Year ______
Paydate ___________ $ ________
Paydate ___________ $ ________
etc.
Authorization
I authorize each and every payroll deduction as delineated in the above schedule. Furthermore, should my employment at the University of Michigan end prior to the completion of the Repayment Schedule, I authorize a maximum payroll deduction allowed by law to be withheld from my final paycheck. I also agree to repay the University of Michigan, within 6 months of the end of my employment, the remaining balance of the debt that has not been repaid via payroll deduction.
______________________________ ______________
Signature Date
______________________________ ______________
Approval - Departmental Representative Date
[Editorial Note: We will allow departments flexibility in the Authorization to pick and choose a combination of sentences that reflects their position on the repayment. The Payroll Office will secure review by the Office of the General Counsel, when necessary.]
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