Systems and Procedures
A Division of The Corporate Controller's Office
IN

AUTHORIZATION FOR SALARY DEDUCTION
FORM INSTRUCTIONS

Form Instructions

  1. Type – Select one of three options. Check the appropriate block indicating that this is the Initial Authorization, a change, or the termination of the Authorization for Salary Deduction.
  2. PSU-ID – Enter the employees PSU ID number.
  3. Name – Enter the Employee’s name.
  4. Classification – Select one of seven options from the drop-down list. The options include Academic, Academic Administration, Administrator, Executive, Exempt Staff, Nonexempt Staff, and Technical Service.
  5. Position – Enter the name of the employee’s position.
  6. Department Name – Enter the department name.
  7. Furnished date – Enter the beginning date that PSU will furnish meals and/or lodging.
  8. Furnished – Select one of two options. If there is an ending date select the first box and provide the date of the last payment. If the deduction is to continue indefinitely, select the second box.
  9. Lodging – Enter the location of lodging (if applicable).
  10. Deduct date – Enter the beginning date of salary deduction.
  11. Deduct – Select one of two options. If there is an ending date, select the first box and provide the date of the last payment. If the deduction is to continue indefinitely, select the second box.
  12. Table – The following information will be entered into a table consisting of eight columns and three rows. The first row pertains to information for the fall semester. The second row pertains to information for the spring semester. The third row pertains to information for the summer semester. The columns are as follows:
    1. Column 1 – Location of Meals – Enter the name of building where meals are received.
    2. Column 2 - # of meals – Enter the number of meals received per day.
    3. Column 3 – Meals – Enter the dollar amount of charges for meals. Enter numbers only. The leading dollar sign has been provided.
    4. Column 4 – Room – Enter the dollar amount for room charges. Enter numbers only. The leading dollar sign has been provided.
    5. Column 5 – Family Dwelling – Enter the dollar amount for Family Dwelling charges (if applicable). Enter numbers only. The leading dollar sign has been provided.
    6. Column 6 – Other (Specify) - If any other charges incurred, provide a description of such charges.
    7. Column 7 – Other Amount – Enter the dollar amount of any other charges. Enter numbers only. The leading dollar sign has been provided.
    8. Column 8 – Totals – Each of these fields are calculated. No entry necessary.

  13. Pay Periods – Enter the number of pay periods over which the total deductions are to be divided.
  14. Deduction Per Pay Period – This is a calculated field. No entry necessary. This is the amount to be deducted per pay period.
  15. Comments – Enter any clarifying comments pertinent to this deduction.
  16. Employee’s Signature – The employee must sign and date the completed form.
  17. Distribution of Credits table – The following information will be entered into a table consisting of four columns and three rows. The columns are as follows:
    1. Department number
    2. Fund number
    3. Object Class
    4. Amount

  18. Continuation of Distribution of Credits table.
  19. Premise – Select one of two options. Select the first box if the meals and/or lodging will be furnished on University premises. Select the second box if the meals and/or lodging will not be on University premises.
  20. Convenience – Select one of two options. Select the first box if the meals and/or lodging are furnished for the convenience of the University. Select the second box if the meals and/or lodging are furnished for the convenience of the employee. In order to be considered “convenience of the University” an employee must accept room and/or meals furnished on University premises as a condition of employment.
  21. Explain – If the meals and/or lodging are furnished for the convenience of the University, explain why.
  22. Approval – Obtain the appropriate required signatures on all copies (see Policy FN18).
Image of Authorization for Salary Deduction Form