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Office of Human Resources
HRIS PAYROLL ADMINISTRATION
Phone: (818) 677-2101
Fax: (818) 677-5870
Mail Drop: 8229

Prior Pay Period Adjustment Form - Federal Work-Study
(Print this form in landscape format)
Dept ID:
Work-Study On Campus:
Work-Study Off Campus Non-FICA Agencies:
AGENCY: 253
Department:
Pay Period Month:
Year:
 
ADJUSTMENT OF PAY TRANSACTION:
Payroll Current Month: Payroll Prior Month: Hourly Pay Increase: Hours Underpaid:
Hours Overpaid:
Request pay for W/S Student(s) when department has missed transmitting deadline. Request pay for W/S Student(s) from a prior month when employee's hours were not included in regular transmission. Request increase in Hourly Rate from a prior pay period. Requests must be approved by Work-Study Office. Report underpaid hours from a prior pay period. Report overpaid hours from a prior pay period.

JOB CODE LEGEND:

       
1151
ISA, ON-CAMPUS WORK-STUDY 		1153
ISA, OFF-CAMPUS WORK-STUDY 		1871
WORK-STUDY ON-CAMPUS 		1872
WORK-STUDY OFF-CAMPUS		  
 
CSUN ID
Record #
Employee Name
Job
Code
Serial #
EID
Hours Worked
Hourly
Rate
Total
Gross
Pay
Balance
of W/S
Award
1.
L
2.
L
3.
L
4.
L
5.
L
I CERTIFY THAT THE INFORMATION ON THIS WORK-STUDY PAYROLL ADJUSTMENT FORM IS TAKEN FROM THE SPECIFIED STUDENT TIME SHEETS FOR THE PAY PERIOD INDICATED, AND THAT THE TIME SHEETS HAVE BEEN CERTIFIED BY SIGNATURE OF THE WORK-STUDY STUDENT WHO WORKED AND THE SIGNATURE OF THAT STUDENT'S SUPERVISOR.
Note:Properly certified and signed time sheets must be maintained on file by the department for five (5) years.
TOTAL
GROSS PAYROLL
FORM COMPLETED BY: EXT:
AUTHORIZED DEPT SIGNATURE:____________________________
PRINT NAME:
DATE:____________
WORK-STUDY AUTHORIZATION: ALL TRANSACTIONS SUBMITTED ON THIS FORM MUST BE AUTHORIZED BY THE WORK-STUDY OFFICE. PLEASE FORWARD THIS FORM TO THE WORK-STUDY OFFICE FOR APPROVAL. WORK-STUDY WILL FORWARD IT TO THE PAYROLL OFFICE.
WORK-STUDY AUTHORIZATION:____________________________
PRINT NAME:
DATE:____________
*Payroll Office Use Only *
Date: Batch No: Initials: Total Hours: Total Rate: C-80-10 OHRS-PS rev. 02/2011