Instructions for payroll processor:
1. Fill in the form within your browser.
2. Print the completed form using your browser. Use File/Print.
3. Sign and date the form in the space provided.
4. FAX the completed form to the Direct Deposit Specialist in FMS Customer Service at 812-855-1879

Employee Information
IU Employee ID number:			Name:

Type an "X" in correct field below; type in pay advice and check information:
Pay Schedule:

Biweekly

Monthly

Pay Advice NBR:

Check Date:

Net Amt:

Reason for Requested Action: Indicate why by checking appropriate box with an "X":
UNEARNED: The employee did not perform services and should not receive payment from Indiana University. This deposit will result in an overpayment by Indiana University.
OVERPAID: Transaction amount is incorrect. This deposit will result in an overpayment by Indiana University.
TERMINATED: No longer employed by Indiana University.
DECEASED
EMPLOYEE REQUEST, Type in reason:

Steps you as requestor must do:

1. Review paycheck data: Does this payment include any hours or amount from another record NBR or dept.?

Yes  Payments from other jobs/departments/additional payments are included in this transaction.
No   Does not include any hours or amount from another record NBR or dept.

2. You MUST inform the employee that a stop has been placed on their Payroll Direct Deposit.

Requested by   Campus    Dept.
Phone Number Email address
FMS Payroll Processor Name Date Requested

Signed: ___________________________________________________________________

For Payroll Office use only: