ONE TIME PAYMENT split v2 - University of California, Irvine
INTERCAMPUS ONE-TIME PAYMENT
UNIVERSITY OF CALIFORNIA, IRVINE
| |HOME CAMPUS: | | |HOST CAMPUS: University of California, Irvine |
| |HOME SCHOOL: | | |HOST SCHOOL: |
| |HOME DEPARTMENT: | | |HOST DEPARTMENT: |
| EMPLOYEE DATA FROM HOME CAMPUS |COMPENSATION FROM UC IRVINE CAMPUS |
|Employee’s Name: |One-Time/Honorarium Amount of: $ |
|Employee’s ID Number: |Event or Service Dates: To: |
|Home Campus Appointment Title: |Temporary Appointment Title: |
| Title Code: Percent : % | Appointment Title Code: 1650 Lecturer - Misc. 3999 Miscellaneous |
|Annual Salary: $ Monthly Rate: $ |Appointment DOS Code: HON (Honorarium) BYA (By Agreement) |
|Basis/Paid Over: 9/9 9/12 11/12 Semester |Account Number to be Charged: __9 - ______- 2_ |
| |Use ONLY “Non-19900 Funds” Location/Account Fund/Sub Account |
|Current Appointment Dates: To: |Account Name to be Charged: |
|REASON FOR EVENT OR SERVICE AND COMPENSATION |
|(Please Explain the Details of the Event or Service and Compensation. Attach Written Justification for Exceptional Salary) |
| |
| APPROVALS |
| |
| |
|_______________________________ ____________________________ _____________________________ ________________________________ |
|Irvine Campus Date Irvine Campus Date Irvine Campus Date Home Campus |
|Date |
|Fund Source Authorization Dean’s Authorization Academic Personnel Academic Personnel |
|Prepared By: Date Prepared: Information Obtained From: Telephone: |
| F O R P A Y R O L L U S E O N L Y |
EMPLOYEE
IDENTIFICATION NUMBER | |
LOC |ACCOUNT FUND/SUB |EMP
REL |APPT
TYPE |DUC |TITLE |DESC
SERV |BY AGREEMENT
AMOUNT | PAY PERIOD END DATE_
MO DY YR | |1 9 |10 |18 |31 |71 |72 |73 |40 43 |44 | 47 53 | 81 | |86 | |
. . . . . . . . . |FT | |
. . . . . . . . . . | | | |
. . . |
. . |
. . . . . . | | | | | CC: After Campus Approval - Employee’s Home Department /Dean’s Office UCI-AP-71
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