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Payroll Forms
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Form Categories
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| Additional Pay Request Form | Form | Instructions |
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(Microsoft Excel, 02/21/08) Use for: 1) One-Time Pays 2) Temporary Assignments/Workload Adjustments/Projects/Acting/Interim Assignment (Paid temporarily in addition to their regular salary) 3) Overloads 4) Summer Salary for a faculty that already has an appointment during the academic year 5) Summer School for a faculty that already has an appointment during the academic year 6) Temporary Distance Learning appointment 7) Continuing Ed appointment for an employee that already has a regular UND appointment 8) Awards 9) If department submits paperwork late, (so employee has missed at least one pay period) department must calculate amount owed for that pay period and submit it on a one-time pay, in addition to the Job Hire form or the Additional Payment Request form.
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| Address Change Form |
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| (MS Word, 12/09/08) |
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| Designated Medical Provider (DMP) Form |
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| (Revised 2/07)Safety & Environmental Health Form |
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| Direct Deposit Authorization |
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| (MS Excel, 02/06/08) |
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| Direct Deposit Exemption Form |
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| (MS Word, 05/28/08) |
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Hourly Payroll Reporting Form
w/ Formulas |
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(Microsoft Excel, 06/19/09) Use this form to: Report hours worked and leave taken for hourly employees. Leave slips are no longer required, since leave will be reported on this time slip.
Click here for instructions and an example of the Hourly Reporting form
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| Form I-9 |
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| (8/07/09) |
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| Military Family Leave Notice |
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| (PDF, 03/10/08) |
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| Name Change Form |
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| Special Directions for this form: Filling out this form requires you to come to the Payroll Office. You will also need to fill out a new I-9 form as well. Please refer to the I-9 documentation list and bring the appropriate documents with you. I-9 |
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| NDPERS, NDTFFR, TIAA-CREF Previous Participation Form |
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| Mandatory Form - New TIAA Employees |
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| Notice of Employment Change Form |
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| Human Resource (4/27/09) |
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| Overpayment Form |
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| (MS Word, 02/22/08) |
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| Policies Annual Notification Form |
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| Human Resources Page For Mandatory Form |
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| Salary Adjustment Worksheet (HR) |
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| Twelve Month Payment Program |
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| Vision Claim Form (NDPERS) |
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| NDPERS Vision Claim Forms are located on the NDPERS Web Page; Forms & Publications > Forms > Group Vision Insurance Claim Form (2 pages) |
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| Waiver of Retirement and Health Insurance Participation Form |
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| (4/5/05) Used for temporary/part-time or student employees |
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| Additional State Tax Withholding Form |
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| (6/2000) Used to request additional state tax withheld |
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| Form W-4 |
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| W-4 Helper |
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| (2009) Withholding Allowance Certificate |
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| Form W-5 |
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| (2008) Earned Income Credit Advance Payment Certificate |
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Minnesota & Montana State Income Tax Withholding Please return this form to UND
NDW-R Memo, Form and Instructions
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| Salary Reduction Agreement |
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| (4/09) Used for Tax-Sheltered Annuity Program |
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New Employee Processing / Employee Separation |
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| Form Instruction Manual |
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| (MS Word, 11/09) |
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| Job Data Change or Separation Form |
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(Microsoft Excel, 04/27/09) Use this form to:
1) Terminate an employee
2) Employee transfers to another UND dept
3) Employee transfers to another State Agency
4) Pay Rate Change
5) Leave of Absence
6) Job Reclassification
7) Position # Change
8) Promotion/Demotion
9) % Appointment Change
10) Functional Job Title Change
11) Academic Rank Change
12) Change Contract Dates for < 12-Mo Employees
13) Other changes except Funding Changes (Use Position Funding Request) |
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| Job Data Hire Instructions |
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| (Acrobat Reader, 04/01/08) Use: Completing Job Data Hiring Form |
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| Job Data Hire Form |
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| (Microsoft Excel, 09/7/06) Use: 1) Hire a New Employee 2) Hire an employee that is already working in another UND department (Position must be continuous and in an occupation different than the primary position) |
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| New Position Request Form |
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| (Microsoft Excel, 1/1/09) |
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| Personal Data Form | Page 2 |
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| (Microsoft Excel, 02/26/09) Use: This form is completed by new UND employees. The form has been printed and is contained in the new employee packets. |
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| Position Funding Form |
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| (Microsoft Excel, 07/1/09) Use: 1) Indicate default funding sources for a New Hire 2) Change funding sources or percentage of funding for current employees 3) If position has workstudy - indicate funding for H14 Workstudy - specifically. 4) Default funding can be overridden by submitting a time slip for an hourly employee with different funding sources, or submitting an Additional Payment Request with different funding sources. |
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| HRMS Department Access Request Form |
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| (Microsoft Excel, 05/29/09) |
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| Foreign National Information Form |
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| To be completed by International Employees requesting preferred tax status. |
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| Employee Consent To Release Name For Donated Leave Purposes |
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| This form is filled out by the employee receiving the donated leave. |
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| Leave Donation Form |
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| Forms for donating sick leave hours. |
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| Salaried Leave and Overtime Reporting Form |
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(Microsoft Excel, 08/01/07) Use this form to: Report leave for all salaried employees and overtime for salaried, non-exempt employees. This form REPLACES the Leave slips used in Legacy. Only send one form per person, per pay period. Example of Salaried Leave and Overtime Reporting Form
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| Day Care Cost Verification |
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| 2010 FlexComp Plan Enrollment Agreement |
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| Calendar Year (January 1, 2010 - December 31, 2010) Enrollment Dates: November 1-30, 2009 |
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| FlexComp Reimbursement Voucher |
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| Medical Spending Account and Dependent Care Spending Account Worksheet |
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| Status Change Form |
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| Outprocessing Checklist |
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| Retirement Checklist |
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| Termination Checklist |
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Salary Retrodistribution Information |
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| Budget Retrodistribution Form Instructions |
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| (4/07/09) |
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| Budget Retrodistrobution Form |
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| Partial Salary Correction Form |
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| Affirmative Action Poster |
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| (08/08) |
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| Drug-Free Workplace |
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| (08/08) |
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| Equal Employment Opportunity |
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| (08/08) |
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| E-Verify Poster-English |
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| E-Verify Poster-Spanish |
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| Family and Medical Leave Act |
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| (01/09) |
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| Harrassment or Discrimination |
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| (10/07/08) |
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| Military Family Leave |
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| ND Minimum Wage |
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| ND Unemployment |
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| (05/06) |
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| Right to Work-English |
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| Right to Work-Spanish |
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| USERRA |
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| (01/06) |
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| UND Fraud |
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| WC Premium Certificate |
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| WC Poster |
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