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Payroll Services Forms

Form

Description

Campus

Add/Change Home Department Code (Webform) Form completed online by authorized department representative to request a new department code, a change or correction of department name, or update department address. UC Davis / UC Davis Health
Request Review of Exercises (Webform) Used by supervisors of employees that have completed the training and practice exercises as required for access to Payroll production transaction processing to request review of the exercises by central offices. UC Davis

Damage Payments

   

Damage Payment Report of Services Performed Before Signing Loyalty Oath (PDF)

Payment made to an employee who performs services for the university prior to signing the State Oath of Allegiance. A damage payment constitutes a settlement of an employee's claim based upon services rendered. UC Davis

Loyalty Oath—Damage Payment Release (PDF)

Payment made to an employee who performs services for the university prior to signing the State Oath of Allegiance. A damage payment constitutes a settlement of an employee's claim based upon services rendered. UC Davis

Special Handling of Payroll

   
Advance Check Request (PDF) Check manually prepared and issued as payment of services rendered in current payroll period, in advance of the employee’s regularly scheduled payday. UC Davis
Declaration of Lost or Destroyed UCD Check (PDF) Used by employees to request a stop payment and reissue of check that has been lost, destroyed, or was not received. UC Davis
Declaration of Lost or Destroyed UCD Payroll Vendor Check (PDF) Used by vendor to request a stop payment and reissue of check that has been lost, destroyed, or was not received UC Davis
Emergency Payroll Advance Request (PDF) Used by employees to request an advance on their earnings for an unexpected, unavoidable emergency. UC Davis Health

Online Earnings Statement Exception (PDF)

Used by employee requesting to receive a paper Direct Deposit Earnings Statement, or to cancel a previous request for a paper Direct Deposit Statement.
Submit to: Payroll Services Office, or fax to 530-757-8597

UC Davis / UC Davis Health
Payroll Address Change (PDF) Used by UCDH employees to notify of an address change for paychecks and statements.
Submit to: UC Davis Health Payroll
UC Davis Health
Payroll Checks through the Mail (PDF) Used by UCDH employee to request payroll checks to be delivered through the mail to an non-campus address.
Submit to: UC Davis Health Payroll
UC Davis Health
Separation Check Request (PDF) Used by department or Service Channel to submit separation check issued off-cycle as final payment for all earnings owed to employee. UC Davis

UPAY 564-3 - One-Time Payroll Payment Authorization (PDF)

Used by department to document approval and submit request to central Payroll for payment transactions expected to occur once, not routinely or expected to occur again. UC Davis
UPAY 644D - Payroll Time Reporting Adjustment Worksheet (XLS) Used by department to document approval and submit request to central Payroll for adjustments to payroll earnings. UC Davis

Transfer of Payroll

   
Dept Pre-Approval Form: Transfer of Salary Expense (Extramural Fund Source)  (PDF) Form submitted by department with Contracts & Grants Accounting approval to move expenses onto account with 120 day restrictions. UC Davis

Salary Expense Transfer Access Application (PDF)

Application form completed by department and submitted to Kuali (FIS) Help Desk for approval to perform SET transactions in KFS, and/or access reports 339 and 340 in FIS DS. UC Davis
UPAY 560-T - Temporary Interlocation Transfer or Multilocation Appointment (PDF) Used by either Host or Home campus for employee with payroll payment coming from more than one campus, ongoing or continuing payments expected. UC Davis
UPAY 644C-T - Interlocation One-Time Payment (PDF) Used by either Host or Home campus for employee with payroll payment coming from more than one campus, one payment expected, not ongoing. UC Davis

Employment Forms

   

Direct Deposit Election (PDF)

Used by UCDH new employees and rehires to provide banking information direct deposit.
Submit to: UCD Health Payroll Office in Sacramento
UC Davis Health
I-9 - Employment Eligibility Verification (PDF) Instructions for I-9 (PDF) UC Davis
Payroll Transmittal Form (PDF) Cover sheet used by Service Channel, sent with onboarding documentation to central Payroll office to assist with accurate and efficient distribution. UC Davis
Self Identification of Disability (PDF) Form completed by employee at time of hire to self-report disability status. UC Davis
Ethnicity/Veteran Status Guidelines (PDF) Extensive instructional guide for entering the completed form into the payroll system  
Self Identification of Ethnicity/Veteran Status (PDF) Form completed by employee at time of hire to self-report ethnicity and veteran status. UC Davis

Statement of Citizenship (PDF)

Form completed by non-US citizens at time of hire to identify tax status as resident or non-resident alien. UC Davis
UPAY 1 - Pay Disposition Form (PDF) Employee completes any time they wish to change way pay is distributed (i.e. Enroll in direct deposit or update address for check delivery). UC Davis / UC Davis Health
UPAY 544 Personal Data Form (PDF) Form completed by non-represented employees at time of hire to provide necessary employment information for payroll and personnel matters. UC Davis / UC Davis Health
UPAY544A Personal Data Form for Union Workers (PDF) Form completed by union represented employees at time of hire to provide necessary employment information for payroll and personnel matters. UC Davis / UC Davis Health
UPAY 585 - State Oath of Allegiance, Patent Policy, and Patent Acknowledgment (PDF)

Mandatory form completed at time of hire. Completion of State Oath of Allegiance section depends on US Citizenship status.

UC Davis / UC Davis Health
Verification of Previous Employment (PDF)

Used by employee to request verification of previous UC, CSU, or State of CA employment.
Submit to: Central Payroll Office

UC Davis
W4 - Employee's Withholding Allowance Certificate (PDF) Used by employee to have employer deduct the correct amount of tax withholding from wages. UC Davis / UC Davis Health
W-4 (Non-Resident Alien) - Employee's Federal-State Withholding Allowance Certificate (PDF) Used by non-resident alien employee to have employer deduct the correct amount of tax withholding from wages. UC Davis / UC Davis Health

PPS & PPS DS Application

   
PPS/OPTRS Access/Change Application (PDF) Instructions (PDF) Submitted by employee/department with approval to gain access to the Payroll/Personnel production system. UC Davis
PPS-DS Access/Change Application (PDF) Submitted by employee/department with approval to access the data warehouse reporting system for standard reports. UC Davis

PAN Review

   
Request for Temporary Mandatory Reviewer (Webform) Form used to request a temporary switch between the Mandatory Reviewer and a Backup Reviewer on the current approved Department Roles Structure. UC Davis / UC Davis Health
Checklist for Departmental PAN Review (PDF) Tool for department reviewers in verifying information on the PANs at the department review level.  
Checklist for Central Office PAN Review (PDF) Tool for central office reviewers in verifying information on the PANs.  UC Davis

Dept Roles Structure System

   
Check Status of Structure in DRS System (PDF) Checklist for checking the status of PPS and OPTRS structures in DRS System. UC Davis / UC Davis Health
Update Structure in DRS System (PDF) Checklist for updating PPS and OPTRS structures in DRS System. UC Davis / UC Davis Health
Add/Change PPS Officer in DRS System (PDF) Checklist for adding/updating PPS Officer in DRS System. UC Davis / UC Davis Health
Central Office OPTRS Org Structure (PDF) Paper form used to submit OPTRS structure for central office or dean's office department. UC Davis
Central Office PPS Org Structure (PDF) Paper form used to submit PPS structure for central office or dean's office department. UC Davis