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UPG Payroll Funding Adjustments

This form is used for requesting adjustments to 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.

Requestor/Approver
Impacted Employee
Date Range for Results to Adjust
*Start and end dates should align with Pay Period Start and End Dates. See physicians group 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%)
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Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.