Category
 

Pay Error Correction/Missing Check Form*

Fax Form To: Human Resources Process Center at 212-851-2990.
* Do not use this form to track paperwork received after the Mail Closing Date.


Employee Information
Employee ID:
Empl Rec #:
Last Name:
First Name:
Employee Status: Active LOA Terminated Retired
Employee Type: Officer Support Staff Work Study Casual Stipend
Employee Pay Group: M01 M02 M03 BW1 BW2 WK1 WK2 RET
Error Information
First Pay Error Type: Base Pay Add'l Compensation Deductions Taxes
Correction: Over Payment Under Payment
Missing Payment (inc. Vacation and Severance)
Stop Pay/Reverse
Pay Period of Error: Start Date: (mm/dd/yyyy)
End Date:    (mm/dd/yyyy)
If known, please complete the fields below.
Amount:
Code:
Tax Periods:
Take Normal Deductions: Yes No
Describe the Pay Error and Reason for the Adjustment:


Second Pay Error Type: Base Pay Add'l Compensation Deductions Taxes
Correction: Over Payment Under Payment
Missing Payment (inc. Vacation and Severance)
Stop Pay/Reverse
Pay Period of Error: Start Date: (mm/dd/yyyy)
End Date:    (mm/dd/yyyy)
If known, please complete the fields below.
Amount:
Code:
Tax Periods:
Take Normal Deductions: Yes No
Describe the Pay Error and Reason for the Adjustment:
Authorization for Correction
Department Approver
Dept. Approver Name:
Date:
Phone:
Department:
Department #:
Email:
Bloodborne pathogens Infectious agents/lasers
Chemicals Respiratory protection
Formaldehyde/Xylene Physician Billing
Radioactive materials Contact with patients and/or      research subjects
Laboratory animals

      


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