Supplemental Payment Form

Supplemental Payment Form

The Supplemental Pay Request Form is used to request a payment (or recurring payments) that is in addition to regular semi-monthly pay.

Requester Information

Please identify who is completing this form.

Requested By*

Begin by typing your name and select from the drop down menu.

Select or enter value

Select checkbox if someone else also needs to be notified of this request

Additional Employee to be notified

If an additional Employee is selected in this dropdown menu, they will receive an acknowledgement notification when this form is submitted and another notification when the process is complete.

Select or enter value

Request Information

Unit*

Select or enter value

Employee Name / SUNet Email

Please select a current FMS employee from the drop-down menu.

Select or enter value

Employee Name / SUNet Email

Please select a current IAIS employee from the drop-down menu.

Select or enter value

Employee Name / SUNet Email

Please select a current OCFO employee from the drop-down menu.

Select or enter value

Employee Name / SUNet Email

Please select a current OCRO employee from the drop-down menu.

Select or enter value

Employee Name / SUNet Email

Please select a current ORA employee from the drop-down menu.

Select or enter value

Employee Name / SUNet Email

Please select a current UIT employee from the drop-down menu.

Select or enter value

Select checkbox if employee ID is not included in the drop-down menu

First Name*

Provide the employee's first name. Nicknames are not acceptable.

Last Name*

Provide the employee's last name.

Employee Email*

Provide the employee's SUNet email address.

Supplemental Payment Type*

Select or enter value

Work Assignment Dept

Provide the department code that the employee reports to.

Supplemental Pay Information

Payment Start Date*

Provide the start date for the pay period in which the payment needs to be processed.

Payment End Date

Provide the end date for the pay period in which the final payment will be processed.

Paying Department

Select or enter value

Payment Amount

Do Retro Hours Payment Apply*

Hourly Employee's only.

Yes

Dates Worked and Hours*

Provide the day and number of hours to be paid.

Example:

02/12/2023: 4 hrs

02/13/2023: 2 hrs

02/14/2023: 5 hrs

Total Number of Hours*

Provide the total number of hours to be paid out. E.g. 11 hrs

Hourly Rate

Provide the hourly rate for this payment. Please be specific for any adjusted hourly rates, such as overtime.

Payment PTA or LD

Provide the PTA for the payment to be processed. If this field is left blank, ""LD"" (labor distribution) will be used.

If the paying department is different from the employee's home department, ""LD"" cannot be used and an actual PTA must be provided.

Justification*

Provide justification for the request and any other relevant comments.

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