Prior Period Non Pay Affecting Adjustments
PERSONAL INFORMATION
NAME OF PERSON SUBMITTING REQUEST:
Last Name First Name
Email of Person Submitting Request:
Telephone Number of Person Submitting Request:
Dept.Id
Empl.Id
Empl.Name
Empl.Rcd.Nbr.
PAY ADJUSTMENTS
Step 1: Identify which pay period needs to be adjusted.
Step 2: Enter earning code that is being adjusted along with the corresponding positive or negative value.
(Example: SCK-8 and VAC+8 when vacation should have been recorded instead of sick leave.)
Step 3: Enter each code that needs adjusting on a separate line.
(If more than one employee needs adjusting, please submit additional sheets.)
PAY PERIOD END DATE TO BE ADJUSTED:
Additional Comments:
Please remember to fill out the EMPLID, DEPTID, and NAME at the top of this form!
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