Employee Repayment Agreement Payroll Deduction CL ...



REPAYMENT AGREEMENT -- PAYROLL DEDUCTION(Note: This method of repayment is not available for Empl Classes 14, 14W, 16, 16W, 31I, 31T, or 34-SPC)DATE FORMTEXT ?????Section 1: Employee InformationEmployee Name (Last, First) FORMTEXT ?????EMPL ID # FORMTEXT ?????Reason for Overpayment FORMTEXT ?????Position/ JobTitle FORMTEXT ?????Employee Status FORMDROPDOWN Empl Class FORMDROPDOWN Payroll Contact FORMTEXT ?????Department Name FORMTEXT ?????Department ID FORMTEXT ?????Overpaid Period Begin and End Dates FORMTEXT ????? - FORMTEXT ?????Gross Amount Overpaid* FORMTEXT ?????*Note: see attached overpayment calculationSection 2: Notification Statement. The purposes of this Repayment Agreement are to notify you, the Employee named above, of an overpayment of compensation that has created a debt from you to the University of Maryland, Baltimore (UMB) and to establish terms for repayment. UMB Policy VIII 99.02 Compensation Overpayment and Recovery and Financial Services Standard Operating Procedure No. 3315 apply to this matter. You are in debt to UMB for the amount of the overpayment. A Repayment Agreement is your opportunity to clear the debt simply and without legal formalities.Section 3: Repayment by Payroll Deduction 1. Payback Amount (from attached calculation) FORMTEXT ?????2. Select Repayment Term* FORMDROPDOWN 3. Repayment Begins PPE Date FORMTEXT ?????4. Repayment Ends PPE Date FORMTEXT ?????5. Number of Payments* (See note) FORMTEXT ?????The last payroll deduction amount will be the same amount as the remaining balance.*Note: Multiple payments are only allowed under limited circumstances. Please refer to Financial Services Standard Operating Procedure No. 3315: Compensation Overpayment and Recovery.By signing this Repayment Agreement, you authorize UMB to deduct $ FORMTEXT ????? from each paycheck over the next FORMTEXT ????? pay period(s), beginning with the pay period ending FORMTEXT ?????. You understand that the last payroll deduction will be equal to the remaining balance at the time of that deduction.Section 4: Employee Agreement and AcknowledgementYou agree to pay UMB for an overpayment of compensation in the amount of (enter amount from Section 3, box 1) according to the terms stated in Section 3 above. You acknowledge there has been an overpayment to you as stated above; you do not dispute the amount of overpayment. You agree that you are in debt for the overpayment. You understand that failure to satisfy your debt may result in legal action, debt collection efforts, and an increase in your liability.You authorize the payroll deductions described in Section 3 in order to satisfy your debt. In addition, you agree that: If your employment with UMB terminates before your debt is paid in full, UMB will withhold from your final pay any amounts still owed by you to complete payment of your debt. In addition, UMB may take all or a part of any earned annual and/or holiday leave balance payout owed to you at termination of employment to satisfy the balance of your debt at the time of termination of employment. If your payroll deductions, final pay and leave payout do not cover the balance of your debt, you will pay the balance in full within 30 days after your termination date. The collection of your debt for overpayment is subject to the State of Maryland Department of Budget and Management Central Collection Unit’s Standards for Administrative Collection of Claims. If your debt is not satisfied in full within 120 days of your termination of employment, the debt will be referred to the Central Collection Unit. A 17% fee is assessed on all debts sent to the Central Collection Unit. You will not be eligible for conversion from a contingent position to a regular position, referral for consideration for a new job at UMB, or rehire at UMB until your debt, including any Central Collection Unit fee, is paid in full.______________________________________ ______________________________________ Signature of Department Administrator and Date Signature of AVP/A Dean/Designee and Date FORMTEXT ????? FORMTEXT ????? ______________________________________ _______________________________________ Printed Name and Title Printed Name and Title ________________________________Employee Signature and Date ................
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