3.100 (Rev. 08/06) MISCELI ANEOLJS CHANGE · PDF file3.101 (rev. 02/87) miscellaneous change transaction codes-required/conditional index* codetiti e/description page 341 on payroll

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3.100 (Rev. 08/06)

MISCELI ANEOLJS CHANGE TRANSACTION CODES- REQUIRED/CONDITIONAL INDEX*

(.See PAM page 2.209 for inactive/redefined transaction codes)

Do not document any Miscellaneous Change Transaction with an effective date the same as an existing transaction in Line 12, which allows this information to be changed. Instead, document a correction to the existing transaction in Line 12 (see PAM page 9.4). EXCEPTION: A separate 335 transaction may be required with an effective date the same as an existing transaction in Line 12 when specified in the alternate ran e criteria.

CODETITI E/DESCRIPTION PAGE

105 SOCIAL SECURITY NUMBER (correction or change) 3.104

120 POSITION NUMBER (change) 3.105

Use for unit/serial number change for MCR I. Use for unit number (no change in duties for MRC II. Use for serial number change for MRC II. Use lor serial number change only for a NO MCR class (PTM 350. 7)

126 COLLECTIVE BARGAINING IDENTIFIER 3.106

Use when employee's collective bargaining status changes and: is an exception to the CB Identifier shown for the class in the Pay Scales; or is no longer an exception to the CB Identifier shown for the class in the Pay Scales; or employee is in a "split class" (shown in the Pay Scales as U01-U20).

130 COUNTY CODE (change) 3.107

215 EMPLOYMENT HISTORY REMARKS 3.108

315 PAY FREQUENCY (change) 3.109

325 PLUS SALARY AND EXPIRATION DATE 3.110

Use to report initial plus salary and expiration date, chang~s or deletions.

330 ANNIVERSARY DATE (change) 3.111

335 ALTERNATE RANGE AND BASED ON SALARY (change) 3.112

340 OFF PAYROLL (10/12 Leave- Rule 369) 3.114

(continued on next page)

3.101 (Rev. 02/87)

MISCELLANEOUS CHANGE TRANSACTION CODES- REQUIRED/CONDITIONAL INDEX*

CODETITI E/DESCRIPTION PAGE

341 ON PAYROLL (1 0/12 Leave - Rule 369) 3.115

345 SHIFT DIFFERENTIAL 3.116

350 SPECIAL PAY 3.117

355 WORK WEEK GROUP (change) 3.118

405 TIME BASE (change) 3.120

Do not use for certification process or layoff situation.

430 * PROBATIONARY PERIOD 3.122

Use for civil seNice employees only. Use to extend probationary period or when intermittent, indeterminate or fractional time base employee completes probationary period.

440 SEX (correction or change) 3.123

445 ETHNIC ORIGIN (correction) 3.124

455 * DISABILITY CODE (correction or change) 3.125

505 RETIREMENT SYSTEM INFORMATION (change) 3.126

Use to report changes of retirement membership.

* For Civil SeNice employee only.

(continued on next page)

3.102 (Revised 02/1 0)

MISCELLANEOUS CHANGE TRANSACTION CODES - REQUIRED/CONDITIONAL INDEX *

CODE TITLE/DESCRIPTION PAGE

545 OATH (change) 3.128

550 MEDICAL CLEARANCE (change) 3.129

555 * FINGERPRINTS (change) 3.130

560 PROFESSIONAL LICENSE (Ghange) 3.131

565 JOB INCURRED INJURY 3.132

Use to document a job incurred injury. Also use to document any subsequent return to work.

705 TOTAL STATE SERVICE (change) 3.134 .. ~·-..... ,

710 INTERMITTENT DATES AND HOURS 3.135

Use for layoff purposes only.

715 SERVICE PAY PERIOD 3.136

1) Use for temporary leaves of 30 calendar days or less (per SPB Rule 361) resulting in a non-quaiifying pay period; or

2) Use for qualifying a pay period while on NDI; or

3) Use for California Conservation Corps (CCC) employees on Federally funded WCTD, or

pending approval of Federally funded WCTD and pay period is non-qualifying; or

4) Use for qualifying a pay period while employee I is on dock and furlough.

*For Civil Service employee only. (continued on next page)

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CODE

GEN

MHR

MSA

ORP

PUN

ROI

SAL

SIS

SPC

3.103 (Revised. 02/01)

MISCELLANEOUS CHANGE TRANSACTION CODES -REQUIRED/CONDITIONAL INDEX

TITLE/DESCRIPTION PAGE

GENERAL SALARY CHANGE (salary range change) 3.139

MULTIPLE HOURLY RATE/TRADE RATE CHANGE 3. 140

Use for civil service employee only. Use for multiple hourly rate or for trade rate change with or without a multiple hourly rate.

MERIT SALARY ADJUSTMENT 3. 142

Use for granting MSA, denying MSA, or when denying MSA for lump sum only.

OFFICIAL REPRIMAND 3.144

(This transactions is no longer in use.)

ADVERSE SALARY DECREASE 3.146

Use for Civil Service employee only.

RETIREMENT SYSTEM TRANSACTION (RST) 3.147

(Initiated by PERS/PPSD only.)

OTHER SALARY CHANGES 3.148

~ Special adjustments for salary inequities. ~ CPA/CPS increase. ~ Restoration of salary following a PUN.

SPECIAL INGRADE SALARY ADJUSTMENT 3.150

Use for granting or denying a SISA.

SPECIAL CHANGE 3. 152

Use for reporting NDI benefit status other than when employee is on NDlleave.

105

PAM 3.104 (Revised 11/09)

SOCIAL SECURITY NU1v1BER (CHANGE)

TO BE PROCESSED BY PPSD ONLY SHOWS ON EAR HISTORY

~u:s-r ..... r~t ..,... M<O ~ NTVII. ...,.._.....,. """' "' ~nH~• _.,.,.

-~~-' 1 tTo·t------1 I .-cr' -. """"'

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6 !To:

7 :to: ""' 70>

.... ... . .. ... lt.. . ""' ... l'tAOI:J I "« IOI( f"'&)-

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o I

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The current date must be used for Item 21 0 when reporting this transaction.

~ ..... -1 .. ~

D ..... " I • I

' ..=;.:,;..·~ ..

- ...

)TE: To change a Social Security number or delete an erroneous Social Security number when employee has more than one on the data base, refer to PA.l\1 page 10.9 ..

--0

REQUIRED {MUST be completed)

CONDITIONAL (MUST be completed when required by ITEM DEFlNtnON)

ONE OR MORE REQUIRED

· (ONE or MORE of these items on this chart MUST be completed for a valid tran$actton)

lJNE 10 Refer to PAM pages 2.204 for specific substantiation required on:

-1 05 Transaction (A copy of the signed Social Security card must be attached.) I

3.105 (Rev. 11/96)

120 POSmON NUMBER (CHANGE)

I...., ..... M0 ICDA. ...,.., ---1 rro .,.

3 To.--...;, 1104 -

4 TO· -

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REQUIRED (MUST be completed!

CONDITIONAL (MUST be completed when required by ITEM DEFINITION)

ONE OR MORE REQUIRED (ONE or MORE of lhe.se items on this chart MUST be completed for a valid tran~;sutti..,nl

-·--~,~

• ' ' . I , 'oo

I I

' IIIIC1'0fa..~yt ... '

...

3.105.1 (Rev. 05/93)

LINES 8 -9 ITEMS:

886 Class Title Variation Code 960 Corrected Transaction

Identifier

LINE 10 REMARKS AND BACKUP INFORMATION:

Refer to PAM pages 2.201 - 2.205 for specific substantiation required on:

1 - Bilingual Payment Authorization (Item 351) .

3.106

126 (Rev. 03/99)

COLLECTIVE BARGAINING IDENTIFIER*

OtO~~ 0

1 tro: I......., .... ...., ...... ... ...

·2 frO: .......... ,.......,. ''' rn ...

I #IA$l -...( ~>H) ~ H'TW.. I I I I . ...

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'on

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0 I OC I

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41To:

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------- - ---~----7--- -----!----~--- 0 M : : : ! · I I I I I I I I

to$....,.,""" tot a...s ~ tO..M 1 ..a~ eor o.u ! J<'U'ItS ! .c~ ••~ uo 04.J ! ~ ~ ..OTt( en t)olr.J ! loOJU 1 ~,..

I ~AilE ~ ~ II _ _, _ _ _ _! __ -~-~~_tJ£~~-.::-----------~ ~A\' . . 0 I ,, --'- --..1----~-- -'---J ___ ----------------t."SJ I 0 ,.,, ..... ,.,..,

Uae when employee's collective bargaining autua changca and:

is an exception to the CB ID shown for the class in the Pay Scale&; or

-. • . . . . . oo as 1ae

~~~

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. ..,...., . . I . . I .

•·

.

I H) I D I • I I I I

u::::..~n:Tf

is no longer an exception to the CB ID shown for the class in the Pay Scales (shaded an:.a information mual be deleted from Item 126); or

employee is in a ·split class" (shown in the Pay Scales aa UO! -U21).

••t) A 126 Tran.saction should only be effective at the beginning of a pay period and

2) A 126 Transaction mull not be used effective PRlOR TO 12102/81.

·=REQUIRED (MUST be completed)

0 CONDITIONAL (MUST be completed when required by ITEM DEFINITION)

e ONE OR MORE REQUIRED (ONE or MORE of these items on·this chart MUST be completed , .. .

UNES 8-9 60 - Corrected Transaction

Identifier

ITEMS:

., f

(

130

-·-0

REQUIRED (MUST be completed)


ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed for a valid transaction)

3.107 (Rev. 11/96)

COUNTY CODE

(CHANGE)

UNES 8-9 960 - Corrected Transaction

Identifier

ITEMS:

3.108 (Rev. 11/07)

215 EMPLOYMENT HISTORY REMARKS

""' SfCU:NC( ~A () (')

010 [)(XU.AENT PROCf.SSING ~ 0 1

soc;:aA.t. S(Q«<Y • EMP'I.OVfE LAST HAM£ I fAST HAUf. IIH'J ...:XU: NTW. PQS(f()N~ OO'f C8 CQ.Nf"'" Ofi'E.R -.. I COOE D COOE I'QSIT"" 8~Tl1 DATE """' I A/JfJC.Y I IHf I QJ.S$ I ~ TO: I I I I :

I I I. I ... 110 '•n 120 1121 ~.., 1123 "' 12<1 "'" ,. ... 1··~·-yy

EFFfCTM DATE AHJ HOli1S E....,.._O'n.ENT HSTORY AEJt.Wt($ Ul.........C~ , . H>l 0 IN> I D I >0 I D .o • H> l II"""""''""' """" 0

,.., I 0 TO: I I I I I '

)3.1 :

I 1 Ill rn I I I I I I I ... zoo fot,4 tOQIYY ,. >01 I I I 1 I I \ 2

I""" """"" AATl WARY PAY 8ASfO ON SAI.AAY F\.US SALAAV fXPfV. TlOH OA TE NHVEASAHY Al.l£RNATE PAYACU. ,..., SPOWI. wwo PAY lETTER PAY l£TTER ... ...., OF PUIS...__ OAf£ IWIGf SlAru5 O#F. PAY . EXPRAT'ION DATE I I

TO: ... IT~~ I ' I• I

310 "' 320 325 I

330 """" 3M ,.. 3-IS ~ · ,..

'" 356 I

3 ' ""' 8ASE

..... , • o.oos APPOHlloEHT E.xf>f\ATIOH CEAT, • '"""' PR084TIOKAAY PEA100 ...,........,. .... ... Ell~ PA.IOR STATE ,.....,.. I.IST OA OAIGH S<IIYICE DAlE I ll()l.AS EnfT STAT COOE I EJO.IG DATE CO<lE I ·- I OAf£

TO: I I I I I I I I

r'i.. ... ... ... .. . I

"' ,,. .,. I ,,. I I ... ..... . .. 4

""""""' ~ ..... '"'"""'""' ~ . ·;:;·;;\ UfWT OAl H """' """"'"' FNGE~T ~ESSIC.)NAlLICENSE J08 ~0 N..UAY COO< ; - &OEFITS NJn<lfWTY ,;. C1TllfH C<.EAAANCE tu.IAY DATE

> ~ . ii,;: . ""' I EXf'IIU.TION DATE COO( I TO:

' 0 0 I I

~~~· It~: .;. I I WCT0/0. l),t.T£ ... .. ... S20 .,. laioi- ... ... ... ... I ' .. . I 5 REASON PAY !JiRIOO TN: TO 8£ PAC tNfWI TNE TO 8E PAD IOU)) PAY l l..U' 5ll.l TO BE PAO t.lAP SU.I fXTRA HOI.ItS LIM' ...... ,... Sf.PAHATION EXPftATION FUEO MA•HENAHCE

FOA M.ED. .... FIRST /FINN. 0£0 SIEPAAA· I I I I I I 1 I PAYloENT \Hl I,._ DATE I """"" '""' ------- ____ J ____ _L __ _ ____ ..J _____ L __ _

lSI I I I I ceDE I I I I I I -----'------'--- I I I I

TO: I I I I I I I I I I UONT~V OED - ------ ----..J-----'---- ----..J-----'---- 0 M I I I I I I I I I I I I I I I I I I I I I I I I I I

6 80l 60!. t.o.I/YY c.oe CAS f HOUlS I t()TH 607 OAS I I-IOI..I'S I Jo()lH ... 1520 0AS I ~$ 1 HOTH 625 ()AS I ~S I MOnt 630 ... I "' ... I ...

TOTAL STATE SEAYICE HTlRMIHfN .~JES M HCX.AS SEJMC£ PAY ~. '"':", ...... .. RE~O't'LENT ·'f::_, ......... ov ! . 11 -----L--J--------~-------L--J---------~ """"" UST et..ss UST EUG . ~ , TO: """' I HOU1S I ASOF -~

~,' I I 2) _ ____ (. _ __ , ______ _ _ Jtfti _______ (. _ _ J ____ _____ tf!S

~·;t #; .

''Ct. I I

~~~.-tA..---Lrr;-'---;:;,--:-- 1':!'!!--- ----L-oo .L--;:;,-----~ 'loo!• -: ~· ~ ·~' ,.:; ·';~ ''· 70S I I 71S twaot/VY ..... ,,. ,,.

7

1. Refer to PAM Section 5 when documenting an overpayment on a separated employee.

2 . Refer to PAM Page 5.99 when documenting a transaction that requires the entry of PML 2007-026 and Item #215 is not available for entry on the transaction being entered as a new transaction or correction.

- REQUIRED 8 9 ·- (MUST be compl~ted) LINES - ITEMS: 0 CONDITIONAL

(MUST be completed when required by ITEM DEFINITION)

960 - Corrected Transaction

e ONE OR MORE Identifier REQUIRED (ONE or MORE of these items on this chart MUST be completed f~r a valid transaction) 1 ()Ll.hrll

3.109

315

1 TO:

lm

2 0 TO: I'O

71>

(Rev . 05/88)

PAY FREQUENCY CCHANGE)

,rr,Q(fiCY I ~ I Q.ASS I I I I

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0 ....

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3

5 TO:

HP_

6 TO:

7 TO: ,.,

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.=. :-=:.;Mr. ..,a;, .:• ~1\'f..!:.,-4!..:_ . . : ~ ·· "" . .. . ·_ .. 1_ ,:: :!.: - - . tlt -l..C. TO .If. "A4to..DI

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eCI6 ~ I ~ I t<)fM tor Oo4$ I t<Q..AS 1 o-C)I'Iof U0 O..S. I ~ I .Cn< &)') 04$ I ~ I t<)fN 11)

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3.110 (Rev. 11/94)

325 PLUS SALARY AND EXPIRATION DATE *1

- . .........,. ..- _Q_.,_Q_

... ~.....,.,.._.. ........ 0 SOQ.tr,j_ SI.Q.Al'f'" • '(WI.Ovt£ w-r- ~ PMf ~ #HJ ..xu: Hl'W. ,..,...-a,..-

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'" "' I ' I I I I I ,,... "' 1,., I . I I I . l:w' . . 1_ .............

~ .;~ IIWWO..,w,uiT ........ ...._.... ~""" -;""' ... = .. ·:.~ ~· ~ - ... ':""' ,.;:::...~·~" . . ,. ' . --- ' *2 ' ' '

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. ...,. ~ ........ <>< (Dl •

e'if '~' .. ~ "'"""""' ... = '~" I~"

""" '..,..... OOCf I EN:Ji..GOot.n 00011! tFa...l """ 1 ' ' ' ' ' ' I ..,. ... "' I ,.,. .... ..,. ' I'<» I I 1- ... ... ...

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'"" -'_"!_ ... I .,.,_ .. ,_ ,_ ,., . I "' "' I >eo ' _,., : .C:I'OIQ. C)it.ft

:~:: ... "'"""' __ o~~-ll :n ·~ ~·~_'Q_p _, .... S\.w10 01'~ ............... ..,., ·~ ·-""" ....... ,..,.. ,.,.....,.. "=:::::: .. ~

' ' ' PA""""(.._f - ' ........ O.f1 '..,...,. JO. ... ' ' COO( ' '

TO:

____ .. ____ ...~. ___ ' ' '

' ' ' ' ' ' ' ' -·----- -~-----:---- .. ----~-- - --'---- 0 .... ' . I ' ' ' ' ' ' '

' ' ' ' . ' ' ' l .... ' <03 6(11, _.,.,,. 6Q60,....SI~ II"()Tiot 101 Do\.S I I'()UII:S I 1'0"" '" ""'""- - ~· .., ... ..... ,., """'' ,.. lO>O lm r .... ' .... ....... , ._... omow'""' "'"' .. ' ~ . ,.~·· ' Lisr'O...SS = ~~c:.· .. . .. ..

~·:~~~ ...,. '..,..... . .. "' ;: ==:=~~==~===:= = =~===== = = ===== = ========: ;,, ., .·,.? .. :.~·~.i:; ITO; ' ' ' . ,.. -.. ··" "" . ' ll\.-.;;-7-rl'- ;- -~ -.... -- ,..:." ___ ----- -- ---- ---- :"!!. H~ .... ...... '-- ,, '"' 130

,,_ ,,~ ,.

* 1 For reporting initial plus salary and expiration date, changes or deletion.

*2 For one-time adjustment of the annual salary for elected officials. This transaction is initiated by Personnel Operations. Personnel Operations will process an additional 325 transaction to remove the plus salary and expiration date. See page 2.43 for more information.

- REQUIRED !

8 9 - (MUST be completed) LINES - ITEMS: 0 CONDITIONAL

. (MUST be completed when required by ITEM DEFINITION)

e 873 - Salary Rate Substantiation, Above ONE OR MORE REQUIRED Minimum (ONE or MORE of these item s 955 - Multiple Hourly Rate on this ch art MllST 1\4> rnmnlo•o~ r.rr. ~ . - -. - - . -

l

3.111

330

(Rev. 05/93)

ANNIVERSARY DATE (CHANGE)

..,. W<U>C2 .._,. .1.Lo. _o_ I

... ~~ o I

!""""'... ............ I ""' ........ : ~"'~: '~1 .. !!::; '' 1·;;~ I ~.- I ";;."-·1· -· I~··': .... : . .;.;.:.~ .... ;.:.. I ~r. r~ I t":-=-1 :: ,.... ).6\ ~· ~ I

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I .aA$ I AS 0# I ' I I 0 I



ONE OR MORE REQUIRED (ON E or MORE of these ite m s on this chan MUST be completed for a valid transaction)

...

......... ~•.:.at.I'AL I ~...,...s;.....tt : ..... ~

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IS' I I I I

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r~ CA: I ~! ~ ..c- t..~ :....! I OOOJI' ! r <- 0:

LINES 8 -

I ....... . . . I

I

9 955 - Multiple Hourly Rate

.. ,

ITEMS:

960 - Con ecred Transncrion Identifier

335

1 TO:

3.112

tlf:l1,1 N.A .... I¥C ..:0.( HI~

' ' ' ' ! ...

(Rev. 11/92)

ALTERNATE RANGE AND

BASED ON SALARY CHANGE

•r.lt<. 't I LUI

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t--'1-""--~:':""':'-:-~~- ~:-'1: 60f o-.s 1

..c::v-1 1

f'C"'' 10' o·~ ~ o<'\~s ~ ....-':'1-o ''' ;c : ..... 1o : ... ;, li ~U ... ".- , ... -.:•as .. o.c ""'"••s ~ Sot"•""" ,. .... ,

7 TO:

'"'

-~ 0

I lo().Jit1 I A1 0'. ,, · _ .. ' .. .... .! .. .. !"!"~ - - -'-- .. ! .. .... .. .. .. - - ---- ----- - • - ~ ii"(#ICJO

. •. --·-- --'O!.'!"l- --·---~-- -- ~ ----- -------- --~ ~~ .. -.. -'-¥!-~ .. .. !~-,- -·- ~ -'-~- -- -- - -- --- -------~ -,,,.__,_

REQUIRED (MUST be comp leted)

CONDITIONAL (MUST be completed whe n required by ITEM DEFINITION)

ONE OR MORE REQUIRED (ONE or M ORE of the5e items on this ch art MUST be comnlPr Prl

... ..r. ' .......

' I ' ' I ' ... 1 ... W \

I .00~0""'"''

IN.JJft Qoo.f{ c.::ao'

: we~.o. , .. , , 10 '

~tOlD

' ,

(

fFtm 3.113 (Rev. 05/ 94)

UNES 8 -9 ITEMS:

851

863

864

Alternate Salaty Range Criteria (for Civil SeiVice employee only) Intermittent Hours Work Expected Legal Reference for Annuitant

873 Salaty Rate Substantiation, Above Minimum

876 - Anniversaty Date -Second Accelerated

955 Multiple Hourly Rate · 960 Corrected Transaction fdentifier



1 - Alternate salary range other than "A".

EXCEPTION: lf this transaction is moving the employee to range A, enter an "X' in the 110n File For Audit11 box for system reasons.

C:\WPSI \t)cx:sv> AM\3.1 00118

E: -t/) ("')

~ [Tl

0 c t/)

~ Cl [Tl

~ (/)

~ 6 z () 0 0 [Tl

w w c..n

3.114

340

WX..O.. XCIJir t • '""" ' ...... ofloiC)t.«Xl.i ... """ I

(Rev. 05/88)

OFF PAYROLL *1

,.,.,.,.. ..... ou-"""'

.. IICilA<I ..... _Q__Cl'_Q_

ttO CIQO..t.ol.ltt'l .-oczs.c. .........:• 0 -""" . ~I - . ...... 1-. I . I

I I I . 1 TO:

"' I

"'

2 TO. . ............ ..,. ......... ... ·~

~ "" ,., - "'"

• I-"-""-" ......... ... ~o.~· ... ....0 3 TO: ' -., .................

,., • .oo

""" I ICUU I I

••: ... "I I

"' :..; .........,... .~ O::.:";:i" •~~~CTT.l ... . . j.:~· -: .... .. .. .. . .. '"' I• '• . ...

... """""tj' ... lOll;;~-· -- --- -- ~-----:---------- -----L---1

I

... ~ -.. ..-.. .:)( 0.0 , I'OJ"$ I toe• ...

h.4 10 • ~-~ tCL.:: .

I I ........ .J .......... L ......

I I 0 I

----~-----:---- 0 0 I

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... I

0 , ..

l»or. n .u """' I I I ... "" I

.,. I, 1,.,

.., . .. I I

. , !

........... au

..,.

'" I toO I C 0-1 0 0 0 I 0 0 0 I 0 0 0 I

~ '" I ..,... 0 "'" I I 0 0 I I

... , 1-. ,..~

c I"' . )tl :

e · -c' CJ

I l I I .... ' • .• ··r.;. . • ........ . 0.. Qot.l( . .

.... -"""" -:

~· I ...... ...... ..,.. ......:... --· ~U.0.........0-61 ...,._... antJ• o:>..L.-cor

0 0 ., IM .. , ... I I 0 I

1'1 I I I I ____ _ ... ____ .,A __ _ I 0

I 0 I I I I I I

"" I 0 I 0

I 0

~ DoU I t0.M I "'(),. DO

..... I

-II 0 0 I 0 I

., 1 ...

I I I

COOl ' . : -c~IQ. ()oof( ,., lilt : - ·.-...... ~·-• ....... ot :: .......

I . I

I I I

I

7tro: ..., I OOAi 0 I I 0

"'"' II - ---- L •• J •• • ::~~~:"_-~.J---------""' I~" : , ~ .; ~ :· "'~·f.::!• 21 .......... t. ...... t .. .... - ......... .J'fi\J .............. L .... J .................. ~ • . .. .

)I __ ___ !__,.;-'- -------~-- -- - --~-;;- -'- ------- -~ ,,, _, ....... I;; : .. L'IJI , .. *l This transaction is used to take employee off the payroll for 10/12 leave

under Rule 369. (Time off pay status under this rule IS NOT considered a break in State service.

*2 Hours must be blank for academic employees. Payment for hours due employee must be documented on F674 to Payroll.

--0



ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed

. for a valid transaction)

UNES 8-9 ITEMS:

895 960

- Academic Days Not Worked - Corrected Transaction

Identifier

1 046cl8

fttm 3.115 (Rev. 05/88)

341 ON PAYROLL *1

- ......,. - _Q_.,_Q_

... ~fiiiiDCI'~ ........ 0

1 toCWoo. .Q.IIIIrt'r-

r-om~-............ ..o..a:a.t .......... ......,.,.._ _,

"' .,..,.. O"C" -I """' 0 au ..,.,..,. _,.,.. .. -tro: . I _,.I -

I .._ 1-I I I I I I I . I - ... I I" . ,. ~ ... I, : ... ,.,.

~ ... "" ... .;. ~ ~ClllnMIOIC:U'IDo ~,.,~~ .. ,~,-.eM . . ..

lOCI I D I M> I D tro: · -·~ ....... 0 ..... • I 00.

D ..... o · . 0*2 • I I . . Ut :

. I ... rr • • I • I • • . "" '"' _,CD •~ ... •• • ~ ! I • • '

2 , ____ ....,..... I ...a<..,.. ......... """'....__, ~""...::.:! -.:;- .. = .. ~~ :;. ~ - .. , ~ :-qll .. , I' ... _, ...... f"'iorQaf\

' ·- · . . TO: --- . . . 3

) • :' .. ""' ,., . !»> ..,._ l:D> I~ lJO!! -~- lJO> '"'

. lt•4. ~

1..~ ,. ~ ~--........

'~ ""''. ;00

__ ,._.., ..,., ' _,., ..

L I= ~ .. TO: ..... I ....... e-n .,., """' . .._,.,...,. CUll I - I .....

I . I I

•· I . . ..,.. .. I ... . ... ""'

I .,. I ,. ... .... --4

~o:[~~- ~ ........,.... ..::::. . -~; ..=.. """' -- ..:DC.o.. - ~uo-., Lg..a; I ~~D ~· _.. - -~

- ~ ...-.a ........... ."'ii::J.·,. · . •

~-~~ ..... . ~t'DICW.11 au ' ·:... DO I . .. . . -... . :;· -~: I I tiiCTOIQ. OlTt: ... !11! . .,. ... .... ... - - ... I ... . I

.5 .. "-'>

··· ~.q.••wo ..... , R. 0 • •..c fCl.Dt .. ~: &a~ 0& toO _ .... ,,_...,...

~ ...- .... __ ..... -.ro.

fa(D~14-...c... .,. ....., ....St lf ...... OIJ) .......... ------- - -- - ~-~~~---I I .. I . . ... _ -·- .. ... , ........

TO< ____ .J __ _ _ _,_ ___ ... . I . I caa . .

~0: . . I I -----4.----~--- I . . .

I I 0 . . I . . . --·--~-~~~-t=:r=:T: -----'-----'---- 0 ,., I I . . . .

I I I . . • • . I I . . . . • . .,., .,, OilS t IOQ#ID ! ta,.... ... QO~~~·tO""" CKO.S'~ ' """"" .... ... •.,. .. , . ...

6 .. .... .. .....,_ '1-----L--J ... ::::~~·:·~~-~-J---------~ I~" Itt~~ - : . ~~· ,_., ..... <>All . •,

TO: ...,. . ..,..... ' '"" ~·:.!.~.-· ""! !

. • ' I n -----L---'------- -.Jt:I\J---- ---L--.J.---------1111 J:!-&: '• .·: . '

"" . ' ~~ ---__ !,, -~---;,- -:--~-----__ ,_ -rn-'---;,--- - -~ .

'" .aJITT !~ .·:·. .... - "" ; .. .. 7

*1 ·This transaction is used to return employee to pay stalus from a 10/12 Leave under Rule 369. (Time off pay status under this rule IS NOT consi_dered a break in State service.)

*2 Hours must be blank for academic employees. Payment for hours due employee must be documented on F674 to Payroll.

- REQUIRED 8 9 - (MUST be completed) UNES ITEMS: 0 -CONDITIONAL

(MUST be completed when required by ITEM DEFINITlON)

895 - Academic Days Not Worked

e ONE OR MORE 960 - Corrected Transaction REQUIRED Identifier (ONE or MORE of these items on this chart MUST be completed for a valid transaction) 1 04'6cl9

F~m 3.116 (Rev. 11/93)

345 * SHIFf DIFFERENTIAL

1 tro:

4 TO:

5

6

7

rro: "" ... ....,

'"' .,. ......... TO<

TO:

""

tro :~-~

*

-·-0

-~·-/f< " ---~--,'~=-~?;~::,·; : ~·: ·. ::; ue

M»CT I -I 1 ..... I

I I

.,., '"' 1 ...

a::a I __,.,.n I .

.., I

00. ...,.,..... CI1VDt cu-...a

D ... -

·-1 I

...... """ ..

•• oocu.etf ~ 0 _,.. .... ,

1m 01 ""

no ..,. ----

~··,~, .,., ...

TWt :1 .......,TOt .. " cx:or: : """"""' o.n - I ~..,.,... ... oc-.::....,.,...

1 wCTDtO. cw.n ...0 ~ toU I

~~~~f~~~,j~~~ ~~~~·j~~~~±~~~ -co ... -~·=-f--:~1~~- ~~u-1~ H~ :;-=- --=~!;: ·:~~ t I I l I I I t I I I I t t t I t I I J

~ .... , ,.,. 101. O.U ~ I'ClU'a 1 loO""' _,, O..S 1 .0....S I """- ttt ~ O.U I J<U"S I ~ ut l)l.S I ~ f tCn'M 1::10 OS I «JJ ~ 1 Wil6

1 ::·:-: 0' II _..! ___ .f----~~:!~':_;:1:1_: __ ::_ ___________ ~ ~'"' il . rr~ un cu.sl

: : ~ ::::;;~=;==~==~=;;~=~==================~ "' ...... ~ ~ "' 345 Transaction can only be effective at the beginning of the pay period. To report shift differential for other than beginning of the pay period or rotational shift refer to PPM Section G 050.



ONE OR MORE REQUIRED . (ONE or MORE of these items -- .~:- - L..-- •• , ,,...T L - - --- ' - • - -"

LINES

960

8-9 Corrected Transaction Identifier

ITEMS:

3.117 (Rev. 11/98)

350 SPECIAL PAY

~ SfQ..RfY • I I ASl ~ N4J '-CX1..( ..nw.. I

1 TO:

...

.. , 7 TO:

, ..

--

...

'"' ,,,

""

...

..

I I I

' '"

0 · ,,, .... .,. ...,....

~~..:s~~~

,, 0 0

,,. ...

lt/JDCT I lNT I I ... '•7•

0 --.;:~·

'"' "'

DO lm '" ~ .. , ....

_o~:o~o Q_~:-~~rJ- ~ ~.'- ~ 10 .. :.MJ I I t I -- ---1..-- - -~ - --1 I I I I I

I

l m

,..

----~----7--- -----!------:----- 0 (VI I :

I I I I I I I

606 04S I ~S 1 I'Of"'l tOT o--.5 I ~ I rOfW •lS •10 043 I t-0..11"5 1 t<)fM ~()A.$ I t-O.I'IS I

I o<UOS :3!1 _ _ , ___ ,! ___ _ ~ __ J_~_.J _______ - - -----------~

~-~-Df 1-n--~-.w1-a; 1-n--- -----------·---~



ONE OR MORE REQUIRED (ONE or MORE of these item s --•L :- - L -- •••• -..-a.. -.

I_.._ I I

I"' ., .

CCC( I 'c::JII'W I I 0 .

·· u '

' •.,.

ca 0

-...

..... ,

( ) ...( ]_

. ... COOE I

I I liii'Clt)IO, IMtt

... I

.Sf:I0~TI>t t.x.PfV.IQho

... .!1f .

DATt t ~

I

'

'"'

. .. · .. :. ·\:: ~--- ~-::.::~ "' ~ ~- ; .: [ ·~~.:~~~;;:~

3 .117.1 (Rev. 08/96)

LINES 8 -9 ITEMS:

960 Corrected Transaction Identifier

LINE 1 0 .REMARKS AND BACKUP INFORMATION:


1 - Bilingual Payment Authorization (Item 351).

3: ....... (I) () ['11

~ ['11

0 c: (I)

()

:::r: ~ C) ['11 ....,

~ Cll q 0 z ()

0 0 [Tl

w V1 0

1

2

3

4

5

6

7

PAM 3.118 (Rev. 03/02)

355 WORK WEEK GROUP

(CHANGE)

... tl<U>Cl.....-.. 0 0

... (lOO...a.lt:N'!~SliN:J 0 ......... I SCIOAl SfQ.AfY • ( ..... 0\'ft lAST ...... : .... , - »<> o.cxu NnA< ro5'TO< .._,. "'"' Cll ~ ..... C..T(

I """' D I -.cY I ...., I a...ss 1-

TO: I I ' ' ' . I ' ' "' ... 1, .. '"' :.,. 'm :on ,,. ,,.

"' .,. . .., EFFECT .. DUE N4J ..,... .,...._0.--HO HS TC"" .. ...._. UI-...H<l ..........

11! , .. 10:

,......,..., ............ 0 0 .., ' 0 0 N> I 0 '..,' D [! 0 I N> 0 0

' ' ' ' ' ' ' t>l (21 ' ' ' ' . ' . ' ""

,. "'. . . . . ' ' ___ ......._-... To' .;;~ I"""'"""......,., ...... .......... . ~..:.""~! --;;::':""'' ""=" Ps"'•~ !:'. ~~ """" .... ,.;:.:,~·~ .. ,_ .. ., •·:.·. ~ .

tu: ·~:-::.~ . •.· .:•

. ,,,

"' lB" , ' I"" .......... I= I,.. ,.., I ,_ "" » , ........ ,~....,... ""' """"'"''-''"'""'"" .......

f~~ ... , ..... _ . .....,.,

~ "'~ ... .;.:;:: I"'::'~" I~" ITO: ""'' ' ...... """' ' (-l'f>G O...ll Co(XI{ rl()lllw t ,. ...

I ' ' . ' ' ' '

1- "' .. , ... ' .,., ... i 00 . I , , ' ' ... w> ""' I•"'

~~ -= =:' t? :~"F': ~~~. f\\~ ... .. ~- Q.f.~ ·~-· ""CF(UO... , Q ...

..,.~~ 1To: DO

..... ' ( U"'""''0. l)oofl COOl •

~- · ·."·;· ~- ·'<· ·.:·· ~~ -crl) •O. o.-.rt

"" .... ... . '""

,., , .. ... "" ,. - ,.,

}~ ... '""""' · ~ ou .. o ~wo •• ou .. ,,.....,. .:.o ,_ . ._.. •a • •-o ,_._.., .... ..,... ·;:: ......... ... ~ ........... '-><

~~~~...::~ . ' ' . ' . . . , .. ~ .. , - . ·- 0.'1 • oOJOa ----- ~ ---- ~-- -- -~L--- f- --.J. -- __ .... __ _ "' ' ' ' . c.oa

ITo: . ' -----.L----.J--- ' ' ' ' ' ' ' . ' ~·--- ---- -- --~-- - --:---- ~- - --~-- -- -:- --- 0 "'' . ' . ' . ' . . ' ' ' . ' .

"" 60) ~. ~ ... .0., CMS 1 >O.A~ 1

t-()n. .:)tQ,.\.$1 ~I H)f'M '" fJO 043 1 "'!'S 1

1-()n. &n o.-.s 1 ooOJII1 ' ..,,_ .,., ., . .,. , .. , ... ; ... ., .. ,

""'"""' . , __ , ___ .!__ __ ~;::~;::-:~~·~·-:~------~-- - -!.'!!. ~""" ·:r ·. .. :.."':'&"':!"" '= l~~~ --~-y,~ 1:~ ITO

.., ·~ · .. "' .· ' ' 11 __ , ___ ,! ____ ~---'--- J __ ____ ._ - -- - --- ------~4 . ; ' ~. ·; · .. : I,... . •. •; . ~·: ,,., ' :•.,-.~:- m .!-.v -- ~~-~/-;n"-,; - -- ---- --- - -- - ----~ - .. , ....... ~. "'- '111 '"

- REQUIRED - (MUST be completed) 8 -9 0 CONDITIONAL LINES ITEMS: (MUST be completed when required by ITEM DEFINITION)

e ONE OR MORE 960- Corrected Transaction REQUIRED Identifier (ONE or MORE of these items -- ... L..:- _,_ _ - ~ .... . · -- 0

--

405

PAM 3.120 (Rev. 03/02)

TIME BASE CHANGE (EXCLUDING

CERTIFICATION PROCESS AND

LAYOFF SITUATION)

*1 405 Transaction can only be effective at the beginning of the pay period for EDD employee decreasing or increasing time base as a result of participation in the Voluntary Time Income Tradeoff (V-Time) program.

*2 Required for EDD employee decreasing time base as a result of participation in V-Time program refer to PAM page 2.37.



ONE OR MORE REQUIRED (ONE or MORE of these items nn thic: l""h::art a At I C'T k .... ---- • ...... ..... .....

'I ~

(

3.121 (Rev. 11193)

UNES 8 -9 ITEMS:

863

871 879

· LINE

Intermittent Hours Work Expected Right of Return Designation Time Base Substantiation

891

957

Indeterminate Service Accumulation Other Eligibility Substantiation


1 0 . REMARKS AND BACKUP INFORMATION:

Refer to PAM pages 2.201 - 2.205 for: specific substantiation required on: .

1 -

2 -

3 -

Bilingual Payment Authorization (Item 351).

Decrease in time base.

Transactions requiring 'Concurring Appointing Power Signature' when keyed by a decentralized agency.

3:: ,_.. (/) () [Tl

~ [Tl

0 c (/)

() ::r: ~ C) [Tl

.......J

~ (/)

> B 0 z ()

0 0 [Tl

~ 0 (J1

1 TO:

2 TO:

'

3 TO:

3.122 (Rev. 05/88)

430 PROBATIONARY PERIOD *1

$OC.IAf.. SI(CA.A1' T •

... _Ill ..

·~~ ... "' ""' -"""""'"""' -lO'fllll~

...

ho "'""...-.oD

001 60\ ...... ......

*2 ·to loAoiiOD! ........ , "" I......,<><.,.._, .... .... o

, .. "'

I I

I HlST NAioE M4) a.cnJ """""'" I I . • 1

t n

0 .lU •

"""""""" C)F~U't~

"""""" ....... MJaC't • lHf

I I

tlO I U,

0

I Q.ASS . I I m

N>l I I

>&I I

~ "'=·· :r~

I ,. ""'' " ' »> I ,.. . ""' ...... :;,<"" ....... ...._..,. "'"""' "'"' ...

'" I~ TO 8£ •AO tt«WI

·~ ' ' ' "' . -.. • • 11 • • •• ·.r·.:-.. ·~- .

Jl,oiE TO 8IE P#<Q (Cl.DI '" ......,

(»>T SU.T CXlOf I tNJNl D"Tt

' 0 0 - "' I I l I I I I I

-- --~-- - - -~--- ----~---- -:-- -- ~~ -- -~ - - - - ~ -- - : : I I I I I I

---- ~- ---~ --- ----""!- ----:---- 0 tvl : : : : I I I I I I I l

II I

'•n ·~

.. I.., I . I I • I !

~·

D

~

lw ,.

Cll (XUICTY OTMiflll ..,_, 0 000( POSI'fll>t Df'T" OAr{ 0.81

[l . .., . I I I I I I

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. 0 'loG I 0

' ( I I I I

"'~"" ... T...C ~-STA( ,.......,. 0CJJ1! I

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,...,._,

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' ' ' '

...

""""" ""'' ... M )

~SSIC)N.t.,a._I,.C(N5(

I fOII"""'f()H 04Tt

' ' I

... ,_ . I

: ~Tl)IQ.~T(

SI;P.t.AA1"04 ICPf\.Ar'l()lot FUlfD t.MHT(~

' ,.._

"""' ,:IR$11 J ..... 0(0 ..,.... ., . . .

' ~T'1,T OEO

' . ' ' .

606 0A.S I r()U't:S I o-C)fH _,, OA$ I~ I I<()~ tl) &20 ()l.$ I~ I J<CT"oo &Z) ()oi,.S I~ I I'C)Jk CJG ow ... ... ... 0 .. '"'I """" ~.,.n, .... ..,._.., I"'~·· ~-·- .. ~~g_v;:w ::' ~~~

7 TO:

II --- - - L-- J ____ ___ _ Jtft.I __ _____ I ___ .J __ _ _ _ ___ _ d'\1 ~'tr. •..a:· :~~

ft -----~-- -'- ---- ---.1\fti-------L--J ___ ___ ___ lfl$ f:;t.:~-~ ":_\. .. ...

--0

to_~- --'-_1Q_-'---n--- -.!~----- - -'- m-'--:n-- -- -~ ,,, r.Mirt ,.. . ,,., 101 ,,. ~ ....

*1 Use to Re~ort ;

1 - Compl~tion of probationary oe.riod for intennitterit or indetenninate or fractional time ba se employee.

2 - Extension of probationary period.


CONDITIONAL

*2 •

•



If reporting completion of probationary period for intennittent or indeterminate or fractional time base employee . the date must be the day after the completion date shown in Item 430.

If reporting extension of probationary period per SPB Rule 321. the date must ~e the same that is printed in the shaded area of Item 430

3.122.1 (Rev. 05/93)

UNES 8 -. 9 ITEMS:

871 Right of Return Designation 952 Case No. and Date of Action 960 Corrected Transaction Identifier

I ' • 10 REMARKS AND BACKUP INFORMATION·: UNE

(

r ( ( (

(

-t .. c r

-c t .. ~ (

~

( .. ( ( c r -1 (.

c

3.123 (Rev. 05/88)

440 SEX

(CORRECTION OR CHANGE)

- .......a- _Q_ _D 0

... ~-.xz-........., • 0

1 ~0:1 ooc... ll:>Jr • •

1"""-~ ......... ,_ lf'lllld ' ......... #IC~ ....,_ ...,..,..,.. ..... ...... <» ~ ...... -. au " cxa - - .... , .. .. . j~·- . ....- ·-. I . I . . "I(' :,7. . ' ... .. ~ . ... . I ... '" •r "" . m "' .. , ..... -,.. . I P"f: .:ho\ cwn .....c ~ Oor\.~· JC10'r ,.,__.. "'---~~

1-rro.t "'--· """;::x;: I

. 0

,_1 • lOCI. .. IOC>O .. I oc • ., . ..,, • *1 . .. : I I I I

)JJ :

~ j I ' ' IT . I I

1-I ' i , , __ . . -=:.:.·· ... . . I I . '

2

!ro: ,-'""""-"'" ......... , ......... , ;,.......,... .............. ~ .... .....:;... --;:::;· . ... =:;; • I '"""'- ~ - ~~ -- "~-TI• &•. , •

~ _, L .,."" "'"' •• -...-o. .).oo11 . -10t .... .........,.

i ~ .. .. .~ ..... :»< ' ,,., ~ -- ,, - ,.., '"" '"" '""

3 l , ... ~ ,-- 1 .:. ~ L

~ ... ~ ·~ - o- U."' . ~~I ~ ,~ ~ .~ ...

B~l~~<t .. ~~ .... , . ..,.... ..., "'' an j _,.,..., au .._. . """ rro.l .,., . . I . . . I

·~ "' <X ., . I

...: I ... ! • V La_ 4

TO-~~- ~ ..,....""' ,;;;:. ~~ , ....... ... - o<>- ~

....,._. _,....._ o.a- ..c:t.~ : ""'-L .. . _., ~ '"""' <U-.cT """"' 0.0.:-t .... . ~lOorDiln «a

0 0 I ' I,.. I . W::T'Ct.-0. 00. t'1 ... . "' ,_ - ... iH_ ..,

"" .., ""'

. "' '

5 I --~- ... - t .. . ,. .. -- ~ . . , ... ~ ... ...., ..... ;. . ~~ . ......... , .... ..,... .... ..... ..... --oo- -..-.,.. •.....-: -..-. .............

.....:: ..... ~· . ........ or.: Sl " ..,_ 1 I I t . ' ' . .. __,. - ·- ... , . oQA>

10.. -- - ---- ----.J-----'---- ____ .J _ ___ _._ __ _ m ' . . . axt . ' ~( I I I I -----&. ____ ... ___ . ' . .

I 0 I ------- ---- ~ ____ _:_ ___ -- -- ~-___ _:_ ___ I ' ' . . . WC>r"'\ . cr::

0 ... . . . I . I I I I . . . . ' .

• 1 I f I ' ' . . ' . toe:' tc"' .... .... tOI '>-!'

1oOJOC:!

1oC""- tc•Do.J 1 ~ 1 < •- . ·~ CX Qfo.S I oQJIIa I ~ &..n~ · ~· oc- ex ""' •.,. ... .

""

6 .... . .... J .. I lot ~ I h·- ... .._ ~ i•~·· -~ ~~ .. ; ~-- · ': -- - --'-- - .J ________ .Jl:f\. -- -----~--.J _________ ~ ~ ..-o ILG 0:1- . ..,..., ' "'"' . ' .

~; ~=====~:;::::::::::~: :: ::::~~~ :: ~:::::: . : ~ ' r tt _, ,,.... ,_

"' -- "' .llf -~

7

*1 The current date must be used for Item 210 when reporting this transa cti on.

-

- REQUIRED - (MUST be completed)


e ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed for e valid transaction) 1 046c30

3.124 (Rev. 02/03)

445 ETHNIC ORIGIN

(CORRECTION)

• T-he current date must be used for Item 210 when reporting this transaction

--0



• ONE OR MORE

REQUIRED (ONE or

MORE or these items on

this chart MUST be

completed for a valid

transaction)

LINE 10

3.125

455 (Rev. 05/88)

DISABILITY CODE (CORRECTION OR CHANGE)

* 1 The current date must be used for It~m 210 when reporting this transact i on .

-- REQUIRED (MUST be completed)


e ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed for a valid transaction)

3.126 (Rev. 05/88)

505 RETIREMENT SYSTEM INFORMATION*1

CCHANGE)

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1 ITo:

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~ '"' l. ·· ~ 7

*l H ant tim~ a ft<·r ~rr : cir.'tflten! , er.~:loyee Qtoilifies for P£RS l!!ecntoersnip, rep~ rt a 5Cr~ lru.H:t icr. effecti L' uct latP.r -:.h~;-, the first of the pi:. ) ~eriod afta e.;:r l c1~t ~·:>rl<.s ti-L ~;~;;lifying ti~!?.

If 4 chan.;·' jp time b4SC' quali!ics tne fnl;llf)yee fr.r P(RS cr.P::l~rship, con;;:> let•· : t.;::-. ~05 on ~h~ J. ~J~H:·; n:·~~nt/~ itne' Ba;<> Chang-e TranHctic.n ~,;, ,.,,, qual Hie = UIC' c-;;;>lC.Jee fo r o.:-r.;:,c r·s.hip.

!f erroneous f;.::>:T.~at ior WJS c:~te re d ih Item 505 to .. an appofn~ent , N!port t corrc~teu op;>oir.~c r.t tr~ r.sac tion.

•2 Hu;: ile a cur rtr, t mor t~ ~ ffec tiv!' da tc- fcor ex\?m~t er.:ployees wt.o e 1 ert P~~s tneiRbe r ; hi ;> a ft cr t'leir a!•poi r'!t-:E-nt. [mp~oyee~ sh~ula c~n tart PERS directly rcgar.Jin} t:l igibj] it_:- fer retroac tive service ror ret·i rer:1er.t - REQUIRED puq>oses. - (MUST be completed)


e ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed fnr A VRiiri tr~ nco~,..tinn\ - - - - --

3.127 (Rev. 05/ 93)

UNES 8 -9 ITEMS:

861 Health and Welfare Benefits 960 Corrected Transaction Identifier

If '10 UNE REMARKS AND BACKUP INFORMATION:

.(

C:\WJ>5l \ DO(:SJ>AM.lC>4bU'..3

(. ( r r t ~ .. r ( c t

c

. , I

3.128 (Rev. 05/88)

545 OATH <CHANGE)

1 tro:l""'""- •::.r· • . .,

2 'TO:i .u:z. 0: =:a l ,.. ., •:-.·

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UNES 8-9 CONDITIONAL {MUST be completed when required by ITEM DEFINITION)

ONE OR MORE REQUIRED (ONE or MORE of these items on this chan MUST be completed for a valid transaction)

960 - Corrected Transaction Identifier

ITEMS:

'•l : __ ., ............... ~~ .. ........ cc: :

'ff

1 046c33

I

(

550 3.129

I tlfllll$1 ......... flt#C ..:O.f Hf ...... . . . .

(Rev. 05/88)

MEDICAL CLEARANCE CCHANGE)

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--0



UNES 8- 9 ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed for a '!a lid transaction)


~"

'"'

.. ... ~ ..

I o<>J<\

'

ITEMS:

. .., , I . . .... ( ~ .....

f•-··o-. :,. . · ,

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,,.

1 046c37

! I

Fflm 3.130 (Rev. 05/88)

555 FINGERPRINTS

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2 ro: :~~ - "'~.

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--0


CONDITIONAL (MUST be com pleted when required by ITEM DEFINITION)

UNES 8-9 ONE OR MORE REQUIRED (ONE or M ORE of these items on this chart MUST be completed for a valid transaction)


"''

..., c

I"'. )U :

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ITEMS:

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3.131

560

(Rev. 05/93)

PROFESSIONAL LICENSE (CHANGE)

··~~ 0 ...... 1 ro:~~-~··

1.....:1"1 ........ ~ ..:nJ: .., ..... I I I I

~ ...

'

-=- : =i-= :- ... g; 1 ... ': I~_ tT. ! ,,. ! \T.' ~,~ ·- . ...

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--0

REQUIRED (MUST .be completed)

CONDITIONAL (MUST be completed when requ ired by ITEM DEFINITION)


C:\WPSl~PA.M\ 1~6037

LINES

884 960

8-9 ITEMS:

License - Additional Correcred Transaction Identifier .

I OC o It I I . . I .

...:.:~-~1\

_....a:::

-

3.132 (Rev. 05/ 88)

565 JOB INCURRED INJURY~

- • ..-.. -- __Q___... _Q_

... ~fiiiiiXI-.c.-...-• 0 1

:a.:x-. .R:.Jr• • [.c~•~·-

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0 ~ 0 - 0 .._

0-

0 0 0 0 0 0 0 0

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4

5

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6

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~:,~- - - --!..-rr -'- - -.;:..----~- --- ---~ r;: -'---;;- ----~ I;_ 0 ... 0 0 , ,....,,"' ... I• "" ~ .. 7

*1 See PAM Section 5 before documenting a job i ncurred injury or illness or subsequent return to work.

*2 When the probationary period must be extended. submit a 430 Transaction. See Rule 321 before documenting the 430 Transaction.

*3 Do not enter for positive attendance employees.

- REQUIRED - (MUST be completed)

0 CONDITIONAL (MUST be completed wh en required by ITEM DEFIN ITION)

e ONE OR MORE ' REQUIRED

\

(ON E or M ORE of these items on this ch an MUST be complet ed for a valid transaction) 1 046c37

'(

(

3.133 (Rev. 11/89)

LINES 8 -9 ITEMS:

957- Other Eligibility Substantiation



1046c41

3. 134 (Rev. 05/88)

705 TOTAL STATE SERVICE (CHANGE)

0 I ' ' ' ' ' ... I

1'016'f0. IIIU4If•

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1 )': 11 ' 1/J

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to

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~- .... -:::. :

*l The current date may be used for Item 210 when reporting this transaction.

--0


CONDITIONAL (MUST be completed when requ ired by ITEM DEFINITION)

ONE OR MORE REQUIRED (ONE or MORE of these items on this chan MUST be completed ,,.. ,. .... ...... : ...... __ --- _ .. : __ ,

I

(

-·-0

•1 To be used for:

1) Layoff purposes; or

2) Personnel Operations Us·e.

REQUIRED (MUST .be completed)

CONDITIONAL (MUST.be compll~ted when required by ITEM DEFINlllON)


m 3.135 (Rev. 05/94)

INTERMITTENT DATES AND HOURS *1

LINES ITEMS:

960 Corrected Transaction rdentifier

3.136 (Revised 02/1 0)

SERVJCEPAY PE1UOD ~2

a..w

1 ~~--~~~~~~~~~~~~~~~~~~ 2

5

6

. ..._ REQUIRED (MUST .ba completed)

0 . ·CONDITIONAL · . {MUST be completed w~en l"e~oired -b'( ITEM DEFlNmONl . . r

ONE OR MORE REQUIRED

. · · ~(ONE or MORE- of these items · 011 this chart MUST be 'comple ted

for a valid transaction) .

.. I Use the last day of the non-qualifying or. qualifying pay period. "2 For;

!)Temporary Leaves of30 calendnr d~tys or less (per DPA Rule 599.781) Resulting in a no~-quali'f)ring pay period. DO NOT USE TO PLACE EMPLOYEE ON TEMPORARY LEAVE 11'vfMEDIA TEL Y FOLLOWING A S49. See PAM Section 5 and S5•1 Transaction before Documenting this kind of transaction.

2)Qualifying a pay period whi le on NDl. See pages 5.30 for more information. 3)Califomia Conse.rvation Corps (CCC) employees pending WCTD and pay

period Is non-qualifYing OR on WCTD covered by Federal funds. 4)Qualifying a pay period while on sm. . :5)Qualifying a pay period while employee is on dock and furlough.

*3 Required for CCC employees on approved Federally funded WCTD. (See pago 2.356 and Section 5).

I

(

· fflm 3. 137 (Rev. 02/85)

:LINES 8 -9 ITEMS:

876 - Anniversary Date - Second Accelerated


.LINE 10 REMARKS AND BACKUP INFORMATION:

· ' 1046c46

~ ...... (./)

n ,.., rr::t> :z: ,.., 0 c:: (/')

-i ::::0 > :z: (/')

> n -i

0 :z: n 0 0 ,.., -....J ...... lTI

3 .139

GEN (Rev. 07 /93)

GENERAL SAlARY CHANGE

(SALARY RANGE CHANGE)

a:-CCCI 0 CCCI

...,.. .... ., ·-1 ~0:

'

........... .,..,_ Q ,~ ~-:on" -:. ·-I ,9 17

~·~ :.:.:· ~~ ~-I

•ot '•:-: ... ... w< .. ..; ..... U'l--c~..-..o>

2 ~O: :::---·~ ~7· I -o I 0

I ' 0 I

i

(

I 0

... , .......... . ~-· I . ..,.I -:::··;~

.~ .. , ... ' I ... , .

.., I ..... "' I _ . .,..., """"' I ..,..~~ ... ~-~ g:, • CCCI : OO<o OOTt CCCI : lk7o# : O<Tt -

~ •"'t t ~ I I • ~ _,

~'·I~ .. , .... ...,

-·-

~-

,.., ... lex

:~~~~-t-Q~~-·Q;Qt_Q'~-~Q_;Q_ ~ n·..- ~ .~ ":•<L 1.- ~ ,., .. :~ I I I I - ----'-----~--- I I I I f t I I I I

------- ----~- ----:---- ------!----"7--- 0 N. : ! : : I I I I I I l I

~ _.. ..,. '-X 0.! I ~4. ~ toC"ftoo .Ct ()ooU I t<lJ"'I!' ~ ..c- t•~ UC' DC I ...0.,! I .-o- l:r. ~ I ~ t <"- CJC

· ~ :;: ·~ .. --:"' , •• __ , _ _ _ _! __ :__~~=---'~~~~~~::_".:'::_ ___________ !c"9~J .. ~ •. I I Jl --'-- - 2----~--_! ___ .J ____________________ t"'1S

: ~ ~~-~-a:-'-...:---!'!'=.- - -'-rr-..!-~---------- - --- ----!"! ";_,,_ ;,.

REOUlRED (MUST be completed)

LINES

-·-1 . I I I I

a: !a .. ,

I.e>~: o..U' · .......... .,

aa' : -c'T'DI'O.. D&Tt ..,

DAn t tC&.M I I

.. . ~ . . . . ~

ITEMS:

0 · CONDITIONAL 8-9

·e


ONE OR MORE REQUIRED (ONE or MORE of these items on this chan MUST be completed for e valid transaction)

851-955-960 -

Alternate Range Criteria Multiple Hourly Rate Corrected Transaction Identifier

I 1 TO.

4 TO:

5 TO.

6 TO:

PAM 3.140 (Revised 12/12)

MHR MULTIPLE HOURLY RATE/

TRADE RATE CHANGE *1

...

.. ~COOl

....... .... 0

.... l"""· ()oo ........

0 '"" Lm

....,.,. ..... ~· f \H'IIO...US f~ . ' . . ' .

•,,, '•n '•n

... . . • • •• i

l rx ..... ~ lm .,... :::;;< "" - • ,_,_, .., ......

Cf"1 D ~01,.• .,.... t:::t::Dt ., cax "''Oro.. ... .,... cw11 sw.w:

. .., . . . .. ' '

.... . ' . .

•

I ,. I m

I ,. _,..,

~ . I.., : 0

,., '

• ..., I ID

l

I»

... ,, . ~ ' .. ''""""'Qo. ~-,

•~ """ cax fPoCIH:l o-tt '""":

. i DO \JO ..._ ... , '·· ltw

. . -<~·a. [)oo tt ... .... . ,..., IG w • ..C ,...,. .,., •• 0 Ill "'"' fQ,J)f .. .... ...... ,co. ....... '"' : _ ... ,_.......,

I 1 I I I I - ' ....... """ ...... '"N'•' ....... a :.

·--- -- - ----~---- -~- -- ----~-----}'--- -~---~----J __ _ . f

I 1 1 t I I I

------- 7-----:----7·-- ----~-----:---- 0 ..., : : ·: t t f f I I I t

~ .....,"""' _,. O& S I ~ I ..0"'" ldl 1>-1 f ...o.JI'IS I~ 4'l &.Jot 0oU I r<::l.,IU l ~ ~ (W.J t ~ I 1-0"""' CX

· • ~·"'·at': • . ' ., . .,. .... .,,

.... •·• · """' .. _ . • ' "' ' o<VO> I ~;;;;:,.,., _. ,......,. . ..... a..o.u = ~;~·

7 TO: ""' ... ~ ~~ ' ' ... ..... ... ... L ...... J ......... - ............ ~ ... ................. ~ ...... J ............... _ ... ~-~ ~

.,, _ _ ___ c._ ___ , _ _______ .J'tf\,j _ ______ (_ _ _ J ............ ...... __ " I!- ~

,, - ----L-rr;-'--·---:--~-- -----t.m-'- - -n-----~ "' _ , .... I• La "" '-- '""

*1

*2

--0

Use for multiple hourly rate or trade rate change with or without a multiple hourly rate.

When employee has multiple hourly rates in excess of $99.99. PAR must be sent to SCO/PPSD for processing. See Item 215.


CONDITIONAL (MUST be completed when required by ITEM DEFINITION).

ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed for a valid tr~nsaction)

I

3.141 (Rev. 05/93)

LINES 8 -9 ITEMS:

955 Multiple Hourly Rate 960 Corrected Transaction Identifier

: .:


( \

r•\WO'\,\nf"'rt."'\llAU\ 10 AI..r"I AI.

3. 142 (Rev. 05 /88)

MSA MERIT SALARY ADJUSTMENT *

... SI<U..::t ......... _Q_Of_Q_

... ~Nf PROCEs..s.<t ~A 0

1 $OOAl S(CV'IfT • (l.lilt.QYt( LA$1 ~ I Ff\Sf NAME I>H:J "-'CC-£ H 1W. P()SJT()H ~A OEPO C8 C()U«y OTtEA -' CODE " coao POSoJoO•o 8 A TH ().AT£ .,.,..

I AG(t.C"f I ..... ' OJ.<$ ... _

TO: ' ' ' ' ' ' ' I ... . .. 1 n1 '"' 1

121 ' "' 'm , . '" ,,. ,,. ... t4S ...., Y'T

EFftC TIY( OAJE N<O t<li..AS t~Ol'W:frcf HSTOR'f AE.~S ~·......_~ .. -'" TAAN$A(.TQH C00E ' ..., ' " ,.., ' 0 ,..., ' 0 ,..., ' D . .., , D TO: ' 0 0 I ' ' I ' . ' ' I

I l l 121 I I I I I I

lU ; ' I ,.. 200 ..... /00/YY ,. ""I

I I I I I I 2

........ 1 ............ SAL'AY PAY 8A$£00H~'t "-US SAI,..AAT UPfVt.JION Dl~Tf ............. y ...._rt:RN.t.TE '4't'AO..I. ,...., ,...,..... WWG t>Al' LETTER PAY LEfTfA ... '"'" OF ru.6 SAt..AAv ""'' ....... su.rus ""' PAY . fX~1CIN CMI ( ., ' ' TO: 3011 TOll/- WAA"f 0 0 . 0 0 ' ' ' ,.

'" ,,.

"' I ,,. .......,., .,. ..,

"' ,.. ... , .. "' "" '

3 I .... .... ... , . ""' AP'f>ON1t.'II£Nf (l:JJ'RAIIOH «•• . IYPE OF I"AABA r t()HAIW PERQl UCA .-.cJ'I"- sea H ........: ~SIAl( ........ un OA ~ S(AVC(

OAI£ I ....,., f Xl.l t Sf AT CODE ' fi'()NG OAT( C<XE ' '""u ' DA O(

TO: I ' ' I I ' ' I 4 ... ... ... "' I ,,. .,. .,. ' .,. I ' .. . .. , ... __ la_

ACC()I...NT SAF£lT '""""""' 1: . ';l:r.:,'; OL._..T OAIH NOH· ""DC-". ,..~,......., PACYESSIQJtU.L lCE.NSE ..oe NCuAAf:O H...iJ'' CODE - 8(J<O'fTS MJJHOI'WTY OTilf.N CL""""""' ~'f OAl [

~t TV!'( I OMAIIQN OAT[ COOE I

TO: .. .. .. . ... 0 0 I I

' - I I WCTOIO.. D.Uf ... ... ... ,,. r.,. ... . ,.,. ... '" ... ... ..., I .., I

5 REASON P ot.Y E:l'f.:O Tt.E TO 9E P~ (J<.E'WI T""'E TO DE PMJ t0..0J PAY l '-""" $0.1 TO Bf PAC 1..~ 5U-' fXTM ~"<()..AS liM ' " ........ $EftAAAIION Ekfi'I'\AIIOH ,..~atoa.u. .... rou .• ~c

'"" u.EO ..... I A STIFNA.l 0(0 ~lt/U.. I I I I I I I I P4n.tfHT ""' I

,._ 04ff ' """'' '""' ------- ____ .J _ _ ___ t_ ___ ___ _ .J ___ __ L. ___

tS) I I I I COOE ' I I I I I -----L----.1--- I I . I

TO: I I ' . I I . I ' ' t,.tQ td l'l 'f CEO ------- ----"""------'---- ----""'--- --L. --- 0 lVI I ' I I I I 0 I I ' I I I I I I

' ' I I I I I I I I

"" 60S ....... ,'" 60fi 04$ I 1'10l.AS I t-Ottf 601 0AS I H()C.M I t<)TH '" 620 OAS I MOI..AS I toOTh G~~s 1 ~s I lo()h t .,. .,, . .,. .. , I .. , 6

TOtAl. Sf AU! SEA\I IC£ · 1-i fl!IWHHH O" fU AH I ~ S(Av'Gf PA'f . ._.. :""' .. A(( ....... O'ft.oi{N I

~ AEf.looiP\.OY I) _____ £. .... _ J ________ J'I-..f\1 .... .... _ .... --- '- - _.J _ _ _ _ _ ........ - - ti\S P<AOO l iST Q.ASS usr £Ul

TO: ""' I ..,.,., I "'"' ~: .. =====t=~=:==9==~:=======~=~~===i=====:: }-:. .. ..

I I I I '

lOS I I H~ ~l'f'f ,. .

'"' T.lO ,,. .... , .. 7

* See PAM Section 4 before documenting an MSA Transaction.

- REQUIRED ·- (MUST be completed)


-- ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST b~ completed for a valid transaction) 1 ()ttt:~ c,

3.143 (Rev. 02/85)

LINES 8 -· 9 ITEMS:

867 - Limited-Tenn/Anniversary Date Justification

872 - Salary Increase Certification (REQUIRED)

952 - Case No. and Date of Acti·on 955 - Multiple Hourly Rate. 960 - Corrected Transaction

ldentifie,r

· uNE 10 REMARKS AND BACKUP INFORMATION:

Refer to PAM pages 2.201- 2.205 for specific substantiation required on:

l -Correction to MSA/SIS shown in Line 12 when approval or denial was reported in error .

1 04 6c 52

L cr r r ;! -,.., c c 0

r -

u ): r

-c ::;:

r c c 1""

3 u )::

ORP 3.144 (Rev. 08/91)

OFFICIAL REPRIMAND

THIS TRANSACTION

NO LONGER

IN USE

3.146 (Rev. 08/91)

PUN ADVERSE SALARY DECREASE

0 ICXJootoa. Ko.A'• • "'" 01 c:tVI'. ~lo4 O.Tt -1 TO:

2 TO: • .._."""· "'" P I ()'\

I,... "'I\>'< """

3 TO: -=•--

4 TO:

5 TO:

-..~ · COO(

~\ £•·•

''<O

)1'!-

.,

0 fU!-1 : ............

0 "" """"t'••'"""""t•~- .... .

o.a•r ' ..o.M

.,.

.aa

I ClASS I I

I"' 1--------------1 OC> I

'" I I

lO• I

COO<

~-I I lm "'

C) I K' I I I I I ' I I

D axr

,,. IX ,,. ... I OC> I

12); : 0 I fC) I C

I I I I

---;:!;';""' 1"'.:.=' o,o

,;:~ ;,· ,. , Ullli· . 0 l:nr ..... ,., j,.

"' C> l~' (;IIi ,...,.. SUI

"' '"'

DO ....... ,

1 .. , ,,. llO' ,,..

tf~l OUT I

.. ,

D

·-lw _,..,

I OC> I I I I

0

.... ...,

a·:·o :··· o·~ a· :·" --· _ _, _____ ... 0 _____ _, _____ ... 0_ '"""' ........ t v N • ...._ ar.ou.tc>o l•""""" , .,. ~~~~~J

I fS, I I

I I I ----- .L. ----..I.---1 ' ---- .J --- --:- --- -- -- -:----·; --- 0

I I f I I

I I I I I I I

60C ()&' I r0..1'~ I 1-()t.. tc• o.-.! I ~ I ""'" t H 11(1 Q.\l I ~! I t<)1'H ·~ o.u ·t<Ut\

~ 1 '-':"· · " ' ' "' ~ ,, - -'- --2 ... - --!~- - - '-- - .!. .. -------------------~

....... ~

'1• - -·- -- .! ... - - - !"!"\: ___ , _ __ J ________ ------ ______ ~.""!:

~~ft __ ._ w ..!- ---~- - J- ,., ... .! -,;; - - .. ---------------~

..,,.

1,.

I I I

c~ 'c:::. ..,'!-

..... ..,.....

"" "'

See Pl\1'-1 Section 5 for specific documentation instructions.

=REQUIRED

0 (MUST be completed)


ONE OR MORE REQUIRED (ONE o r MORE of these items on th is chart MUST be completed for a valid t ransaction!

1,..

~---.......

'

3.146.1 (Rev. 05/93)

LINES . 8 -9 ITEMS:

851

874

Alternate Salary Range Criteria Adverse Action and Rejection Substantiation (REQUIRED)

952 955 960

Case No. and Date of Action Multiple Hourly Rate Corrected Transaction Identifier

LINE 1 0. REMARKS AND BACKUP INFORMATION:

Refer to PAM pages 2 .201 - 2.205 for specific substantiation required on:

1 - Adverse Actions

C:\WPSI\DOC5\PAM\1046C/St

PAM 3. 14 7 (Rev. 02/0 I )

RETIRE:tvfENT SYSTEM

ROI TRANSACTIONS * 1 (RST)

. ,., wo....r:..a ..........,. .. _Q__,_Q_

... ~Hf P'fi()C(5.p..() 0 ......,.. 5()U.t..t SLC&..AI'f' • (~Q'I'fti.AST~ 1 FASI ~ ND ....:n.f H floAo&. "''S!f()ool ........etA CfP' CB C;:)..Hl't 6R1M G,l.f( -I COO( 0 COO( """ 1

I .-Gf..CY f .,., I """' IK""'-

TO : I I r I I I r r ... ... '", •10

1 111 l m ~., .,. ... '"' "' . .. I.CS ... f"rf'r

Lw (H( CTM. ()AI( I4HJ ...o...RS (W"\.O"""'Hf ocSfOAT At~$ ..

TO: ~·~· ..... ...... I

0 .. , 111 ' ,.,. ,,. ...... O[)t'I'T "' no "l~L st:Rva:s US( CN..• 2

--- "'-'•""--IL ........ . .. 8A.SE.Oc:>l~1 P\,.US~Y (t,.Pt~V,.to-t 0,...1( ,.,..,...'WfA~'f ...._IE.~ If ""''AO..l ...... ""'"" - G P AT t.(ll(A p," '-''' (" ... '"'0 ~"-US w.M• con """"" STAM OFF ... . [J,P,.PAI()J-1 t).Af'{ . . . . ' TO: 111?' TCnH. w....M't' . ' . . 3 , .. , .. ,,. . m .

llO ~'"' "' ,, ,.. ,., no "'

,,. I

,...,....,. .,.I . ...,, ~''-'E"-' l.IJ"f\Al()N CLAI • lrpt ()#- PA()841o-AY P(.AQ) ...c.R~"""" ... (I,..,..; KIIORSI A.f( Ju ....... ll ~ ........ LIST ()Ill """"' !l"VCL COCf 041[ I

..,..., (WI S1A1 CCOf I £~041( c.aJ( I f C/PW I 04ff TO: I I I ' r ' . . 4 ... ... ... .. . I ... .,. . ,. I ., I I ... ... . .. '

"""'-"' ....,.,,. """"""'

.,.,., ':t.~'

(J.(t.Pl (MIH ...,.. ~"""" ,~~~ ~t~~oG(HS( .00 ..,....0

COO( - B£foEftts - HJ~'t' OJ\Z1N CLE-.a ..uo

TO: 0 • • 0 0 ,.,..

I [ l.ll"fV.JO. O,..J[ COO( I • • I . I I WCTO •Q. t ... ... ... >10 .,. ... "' ... .. , ,,.

"' ... I ... I 5

.,.....,., I',U ptA(X) t~ tO 8£ ,.AD thlft~~t• t -..t to 8l "AO co..ot ... lu-I' k.U TO 8£ PJJ:J \.v.# Sl,..a.l (a tR.t. •o.AS ....... ............ W.f'AAAI<>"t f .. PA-'.f ()N lu..(O -.,..,Tl~

"'" ..a ~ FASt,,......_ or:o S(,....,..,._ I I I I I I I I 1'4l\o(Hf ..., I ....... 04 ... I o0.AS

ION ------- - ---J- - ---L-- -__ _ _ J _ ___ _ L _ __

ISO I I I I COO( I I

TO: I I I I

_ _ ___ L,. _ _ __ .J. ___ I I I I

I I I I I I ' I I I "(»(f..._, CEO ------- --- -.l- _ __ _._ ___ _ ___ _, __ __ _.L.. __ _

0 I" I I I I I I I I I I I I I I I I I I I I I I I I I I I

6 .. , ~ ..... ,.,., 60111 OAS I ~S t telH eor OA$ 1 tOJII'S f t<lTH "' C)O O...S t "0.1'1 I 1-()I"H lnOA.s 1 ~s 1 -on. ""

.,, I "' ... I

"' OIA.&. ~h f. ova. N I(AW I1[H 0.0.1l.~ N4 r0.AS ,Sf.AvGf. ~"'' lllt.f~Ot~Ht

~ P(f'"""'-0" 11 __ ,_- _.J- ___ lt!'L __ .J- __ ,.! ___ -- - ------------ - -~ .. """ usr a...s UST [lQ ..,. 1 ~1 ASCI'

.. TO: I I Zl _ _ , ___ .J ____ !"N __ _ , _ _ _ .J ___ ,_ ____ __ - --- - -----~ ;

I ' ,. .. . ,.

... I I l~~- 00 1 "Tr-- 1~ -.. ;/ -_m-.!-,y------------------~ fi) ~IT 'I' .,. ,. ,.,. flO ,. , .. 7

* 1 This transaction is initiated by PERS/PPSD only.

Note: Correction to RO 1 transactions can only be documented and keyed as part of the out-of-sequence carry f01ward process. DeQa rtmen tal entries can only be in items 205, 210 a nd 960.

If the retirement account code needs changing, contact the PPSD, Civil Services L iaison Unit.

- REQUIRED 8 9 -0

(MUST be completed) UNES - ITEMS:

CONDITIONAL (MUST be completed when required by ITEM DEFINITlON)

960 - Corrected Transaction e ONE OR MORE Ident ifier REQUIRED (ONE or MORE of these items on this ch11rt MUST be completed f o r 8 \IAl it'f t r • nc•,.....;_ ...._\

SAL 3.148 (Rev. 11/96)

OTHER SALARY CHANGE •1

lfR5.1a.&N.E I!.HJ~lN1W.. I

00'1 coot

1 TO: I I I . I Q.ASS

I I

. ..,..... I I 0

3

4

5

6

7

'"' I m I 113 114 1:1'6 lXI I~ ""

I

"' ... 1]1 ...

I UT~O~

TO: -= ... -- 0 • TO:

TO:

TO:

TO:

... •C.COVOI

"""

"''

--

...

...

, .. '"' ... ,,. »'f//HT..,.;:t.t (al"fU.IIC)W

()AT[ I~

I . ... .. . I

Wll • l'f'P( 06

"""" [u.rt SU.l

... ()A I •

cca 1 I

'"'

DO It" '"' lm ~ us 1""- " ' '"

... """" O.f"""'Cl

"'

cal( I f()IIIW I I I I I

.4 ).) I I

f'M 1'\.Rr.JO r~ 10 0E. ~AD tNfWI Ito.( TO l)AO f~ f>At u,.•..P SI.M 10 6{ PASJ lt,.t..P So,.lt.ol ( J.IfiiA rO..fU

------- __ QJ_Q _:_Q_ Q_J-----~~- w.EO lSI : : : : LH'f I ~"'*'l .

I I I I -----~-----'--·- I I I I f I I I I I I I

------- - -- -~-----T--- ----~- -- - -:--- - 0 tvl : : : : I I I I I I I I

I . I

~ ~J.<~U:n 606 OAS I tQ.AS I ~~·" tot OA.$ I ~ I tOfte 61) UO OoU I ><O...FIS I 1-01'" IU 045 1 ~S I I-Oft4 6J!t 1636 .. ,

'no "' l1J'!

*I See PAM Section 5 for documenting an increase due to CPA or CPS Certification.

See PAM Section 5 for reduction or restoration of salary.

*2 Enter if Ahemate Range is being restored after a PUN Transaction.

*3 Enter Item 345 only:

a) when the SAL is effective the first of a pay period; or

OA'l I ..,..., . I . ' I I I

"" I,.,.


b) to correct the SAL when Reconstructing Employment History regardless of the effective date.


ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed fn r oo ,,~r:...., •------·=--'

... ...

(

3.149 (Rev. 05/93)

UNES 8 -9 ITEMS:

851

873

Alternate Salary Range Criteria Salary Rate Substantiation, Above Minimum

876 Anniversary Date - Second Accelerated

952 955 960

Case No. and Date of Action Multiple Hourly Rate Corrected Transaction Identifier


Refer to PAM, pages 2.201 - 2.205 for specific substantiation required on:

1 - Bilingual Payinent Authorization (Item 351) .

C:\ 'I'.'P5 l \DOCS\!' AM\ l v.6C/S..

3.150 (Rev. 12/89)

SPECIAL INGRADE SALARY ADJUSTMENT*

SIS - . .......,. ...... Q .,._Q_

... -~...., 0 .._.

1 1..:::0.... lfc...J'I1 1 • r--~ .......... - I ft'G I -...., .....C ..cn.J ... , _ I ~·~.._. ,~ 1."~ I~

~, ~~~ ... -' .,.,,

' ~·- ' ....... ·-TO:!., I ' ' ' -' ' ' ' .. , ' ... •r •,,, '·:-:- ~ ·n ... 'b ·~ --, .~, ...... :.a::t

I tut: •Ht c;..~ .....C o<I..I'U ,~0~' ()' ~-1 u ' .... -c t.--c»

' 1.0: " ' ..,' " '.., ' 0

~~· " ,.., . 0

10:1 . 0 . ' ' .

l~: : ' .

I . . . . . ' . I ... ' t . . ' ~ ' "" ·1·: ~:x-~ '"

2 r~-M .. ~~- --- , -- ~ [ '0' I~~~-

tu- · ..,..:~ · ,

~-~--- ,, ... , .... ~ t _, ""'~

'~· -- , ... ~ ··- ,. ~ . • ~ ' ' I -

. • f'(,1 ~- OI"'UA~• O.f\ .........a( ., .. T\6 (1/P -· . ~1"0"o0ol'l

ro::. ;.~ .. ~ - ; J . · . 0 0 . 0 : .

• • I ~ • ' • •• ,,. ,... .... . ..... ~ :w~ ')of ' "" "" 3

·~-- --· . ""' ~ ... ... ,, ......,. ,yo.. c ... : .-,,;:,. ~- ...,..._ ... "l....:L -:..;. ...-v. ..... ... ..-. --.,. i. ' • ' l -"'""" Ul ' "' ....... ~ cax ' OClUO> VIW'11'141 CZlCf . .............

axa ·~ · .,.,.

4 . I ~ .. ITO:I I .,.. ... .., .... .,. I. ,-a;;-, .... . '·. ·I= l ~.;:·::

5 TO:j"" ,~· . , .' !,~- j ' .,. l ....,.,......,_ ,c;o.~

"'" ' ~~caT\ ' t - ' I

..,. .....,...~ --::~

"""' . I w';1'1)• 0.. ().0~ . ' ..,

""' ... , ..... . .,. ....... '' ' "'~~f ..... ,_ ....... ~ .. , . ..; , .. .. ...... ~. . .. - ,._ ' J • • -.4 j ........ , ..... """"' , ... , ~ -· · ·- ·~ ~,,, .._ 0(:1'

6 TO:

........ ro-

I I I I I I I I ' - """ . ..,.,., ------- -- - -~-- ---L--- - -- - ~- - ---~-- - m I I I I ' .

' I I I

------- -- --~-- --~--- - ---~-- - --~-- - [] I f I t .

-- -- - ~----~--- : . : M I t I t

I I I t t I I I

. . . . ...,.....,.,., . . ' . I ' ~ -.. _ ~ tw! I ~ 1 "<"'"... r " 04J I 00,... I oo- • ,~ L"') 0oU I 9Qr' ~ I ~- C..~ C• 1 I 000.~ 1

"'(' !'... 0" .,, '•• W> . ... I lo().la I AI 01 . . . . .

... -.~·-· ; 1....,1 "'...,o. . , L& f a......u 10. L.at c...o

'" . "" ,... .,.. ....

* See PAM Section 4 before documenting a SIS Transaction.

*1. Enter Oates, hours and tenths of hours of State service not previously reported up to the effective date of the transaction being reported . (Enter oldest dates and hour~ on fir~t line. Partial b:ginning _and/or ending pay perio~s must be reported as separate l1ne e!ltnes. Report up to a maXlmum of 160 hours pe r pay period.}

·=REQUIRED

0

• (MUST be completed)

CONDITIONAL (MUST be completed when required by ITEM DEFINITIO N) •

ONE OR MORE REQUIRED (ONE or MORE of these items o n th is chan MUST be completed 4- - - - • . .., .

104 6c60/0072

I

--....

3.151 (Rev. 02/85)

LINES 8- 9 ITEMS:

867 - Limited-Term/Anniversary Date Justification

872 - Salary Increase Certification (REQUIRED)

876 - Anniversary Date Second Accelerated (Delete Only)

955 - Multiple Hourly Rate 960 - Corrected Transaction

Identifier

LINE 10 REMARKS ANo:· eACKUP INFORMATION:

Refer to PAM pages 2. 201 - 2.205 for specific substantiation required on:

1 - Correction to MSA/SIS shown in Line 12_ when app.roval or den:ial was reported in error.

1 046c61

-1 ;;o ):> :z (/)

):> n -l ...... 0 :z n 0 0 fT1

(/)

...... (/)

3.152 (Rev. 11197)

SPC SPECIAL CHANGE * 1

1 TO:

3

4

5

6

·7

TO:

TO:

TO:

TO:

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I • Eligibility for NDI benefits when employee is not on NOI Leave (S49) status.



ONE OR MORE REQUIRED (ONE or MORE of these items on thic:::: rh::art ",.f ICT "'"" ........... ,_ ... L ........ ....t

2 • Termination of NDI benefits when employee is not on NDI Leave (S49) status.

Sec PAM Section 5 before documenting this tr~nsaction.

•2 If reporting eligibility of NOI benefits, enter the first calendar day NDI benefits begin.

If reporting termination of NOI benefits, enter the first calendar doy employee is no longer receiving NDI benefits.

"HOURS" must always be left blank.

•3 This item is required if e mployee is participating in the Annual Leave Program.

3.153 (Rev. 05/93)

UNES 8 -9 ITEMS:

957 - Other Eligibility Substantiation (REQUIRED) 960 - Corrected Transaction Identifier

UNE 10 REMARKS AND BACKUP INFORMATION:

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