Additional Pay Form
This form authorizes additional pay for employees. Please refer to page two of the form for a list of additional pay earning codes. This revised table indicates which codes are eligible for 401A, PERA or optional savings plans 401K, 457 and 403B.
Please open with Firefox or Internet Explorer. The signatures are temporarily not available with Chrome. We apologize for the inconvenience.
Last updated: 5/16/2019