<p> Payroll Adjustment Form Prior Pay Period Adjustment University of Maryland Baltimore</p><p>Employee Name Pay Period </p><p>(Last, First): Processed (FY-PP): Empl ID/Rcd#/Paygroup: 0 Dates of Service: Employee Title: Payroll Contact: Department ID: Contact phone: Department Name: </p><p>Description/Notes: Attachment: Combo Code: Earnings Codes: Print out of Job Summary Salaried Hourly New Hires Leave blank, EFP Applies Inquire- Compensation page RRS RRH / ROT C1 Timesheets older than 60 days (Leave Combo Code column Timesheet Leave blank, EFP Applies RGH / OVT blank, EFP Applies) Compensation Overpayment Payback of Prior Period Form, Signed Repayment Overpayments- One Payroll Leave blank, EFP Applies RRR (Negative amts) Agreement, Backup of the Deduction overpayment Compensation Overpayment Payback of Prior Period Leave blank, EFP Applies Form, Signed Repayment RRR (Negative amts) Overpayments- Multiple Payroll Agreement, Backup of the Deduction Department PCA GPB overpayment Leave blank, EFP Applies Payback of Prior Period Compensation Overpayment RRR (Negative amts) Overpayments- Apply Unused Form, Leave Reconciliation, 0000015682 OFA, OFH Annual & Holiday Leave Backup of the overpayment 0000015682 (Remaining LPA, LPH Leave Balances to be paid out)</p><p>Combo Code: Dates of Service: Earnings (This will override EFP and (NFY & HRL must be entered by Hours: Amount: prevent changes through the week) Code: Budget Retro process- see instructions above): From To - - Tax - Periods - - - - - TOTAL </p><p>Signature of Requestor Signature of Approving and Date: Supervisor and Date:</p><p>Printed Name and Title: Printed Name and Title: FS-Payroll Use Entered by/Date: Reviewed by/Date:</p><p>Form PRF-09 (Revised 7/14)</p>