PAYROLL OFF-CYCLE PAYMENT REQUEST EXHIBIT

Form Instructions

1. Employee Name - Enter the name of the employee to receive the off-cycle payment. The name must match the information in WorkDay.
2. PSU ID# - Enter the employee's PSU ID#
3. Business Area - Select the business area name and number from the drop-down list
4. Payroll Type - Check the appropriate payroll type. Options include Monthly Payroll or Bi-weekly Payroll
5. Employment Type - Check the appropriate employee type. Options include Faculty, Staff, Tech Service, Post Doc, Grad Asst. or Part-time
6. Estimated Gross Amount of Off-Cycle Payment - Enter the estimated gross amount of the off-cycle payment
7. Reason for Request - Check the appropriate box AND provide detailed explanation. Options include:
• Untimely submission of paperwork/timesheet/action by department
• Untimely submission of paperwork/timesheet by employee
• HR/Central Office Error
• University Payroll Office Error
8. Detailed Explanation - a detail explanation is required. Enter as much detail as possible
9. Request Prepared By - Enter the name of the individual preparing the form
10. Date - Enter the date the form was prepared
11. PSU email - Enter the PSU email address of the individual preparing the form
12. PSU Telephone - Enter the telephone number, including area code, of the individual preparing the form
13. Dean or Department Head - The Dean or Department Head must provide either a hand-written signature or provide their digital ID.
14. Date - If the Dean or Department Head provided a hand-written signature, enter the date the form was signed. If a digital ID provided, skip this field
15. Dean or Department Head PSU email - Enter the PSU email address of the individual approving the request
16. Dean or Department Head PSU Telephone - Enter the telephone number, including area code, of the individual approving the request
17. University Payroll Office Use Only - this section is completed by University Payroll Office staff