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Medical Center Payroll Funding Adjustments

This form is used for requesting funding adjustments to prior period payroll results that should have been charged to a different PTAO, department, etc.  Funding adjustments must be requested and completed sequentially.  Be sure to review ALL payroll accounting results for the impacted worker prior to completing this form.

Impacted Employee
Date Range for Results to Adjust
*Start and end dates should align with Pay Period Start and End Dates when possible. See medical center payroll calendar
*If you have selected "Yes", the impacted employee's supervisor should update Costing Allocations accordingly.
Add Attachments
Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx xls xlsx.
Provide as much detail as possible including: 1. PTAO(s) the funds should be moved to OR 2. Department Number(s) and Name(s) the funds should be moved to; 3. Distribution Percentage per PTAO and/or department (should add up to 100%)
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
2 + 4 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.