Pay Error Request Form First Name (required) Last Name (required) Employee ID (required) Date (required) Email Address (required) Phone Number (required) Pay Error Type (required) Base PayAdditional CompensationDeductionsTaxes Correction (required) OverpayUnderpayMissing Pay Pay Period Error Start Date (required) Pay Period Error End Date (required) Describe the error and reason for adjustment (required) Digital Signature - Please Type Your Full Name (required) **Please note, after an employees’ third payroll correction submission, any additional submissions will result in a $10 deduction from the employees’ pay check due to processing.
