University of Michigan Health System
Payroll Correction Form
Name:
EMPLID:
Biweekly Paid
Monthly Paid
Record #:
Business Unit:
Pay Date:
PAYMENT DISTRIBUTION (Check One)
Direct Deposit Monday (If requested by 11am each Thursday; pays out the following Monday)
Pick-Up at Wolverine Tower 734-615-2000 (If requested by 11am; Available same day; call before pick up)
U.S. Mail (U.S. Mail Authorization must be on file; Arrival date dependent on Postal Service; outgoing mail sent at 3PM)
Department Name:
Charge to Short Code:
BREAKDOWN OF REPORTED TIME
Date
TRC /
Hrs
/
TRC
/
HRS
TRC
/
HRS
TRC
/
HRS
TRC
/
HRS
TRC
HRS
Was
Reported
Should
Be
Reported
Date
TRC/
Hrs
/
TRC
/
HRS
TRC
/
HRS
TRC
/
HRS
TRC
/
HRS
TRC
HRS
Was
Reported
Should
Be
Reported
CORRECTION REASON CATEGORY (Check one)
Late Timesheet (Dailies)
Appt Change Paperwork Late/Error
Revised Timesheet (Dailies)
HR Entry Late / Error
Data Entry Error (incorrect TRC / Hours)
Is Employee on the Missing Time Report?
yes
Wrong Employee Record #
Did Not Interface Correctly
Check Reversal
no
Comments:___________________________________________________________________
_________________________________________________________________________
Timekeeper (print): ________________________ Phone: __________________________
TK Signature: ____________________________ Date: ____________________________
Authorized Signer: ____________________________
Payroll Use Only:
revised 5/2012
Record only done
Entered into Access
FAX form to 647-1918
Paid
Processed by: