3.100 (rev. 08/06) misceli aneoljs change · pdf file3.101 (rev. 02/87) miscellaneous change...
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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
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The current date must be used for Item 21 0 when reporting this transaction.
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)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)
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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
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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
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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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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)
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 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 '
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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
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> ~ . ii,;: . ""' I EXf'IIU.TION DATE COO( I TO:
' 0 0 I I
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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
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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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3.110 (Rev. 11/94)
325 PLUS SALARY AND EXPIRATION DATE *1
- . .........,. ..- _Q_.,_Q_
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' ' ' ' . ' ' ' 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)
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REQUIRED (MUST be completed)
CONDITIONAL (MUST be completed when required by ITEM DEFINITION)
ONE OR MORE REQUIRED (ON E or MORE of these ite m s on this chan MUST be completed for a valid transaction)
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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
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7 TO:
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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 \
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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
LINE 10 REMARKS AND BACKUP INFORMATION:
Refer to PAM pages 2.201 - 2.205 for specific substantiation required on:
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
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3.114
340
WX..O.. XCIJir t • '""" ' ...... ofloiC)t.«Xl.i ... """ I
(Rev. 05/88)
OFF PAYROLL *1
,.,.,.,.. ..... ou-"""'
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"'"' 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
REQUIRED (MUST be completed)
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 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-
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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 . •,
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. • ' I n -----L---'------- -.Jt:I\J---- ---L--.J.---------1111 J:!-&: '• .·: . '
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'" .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: "" ... ....,
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TO:
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~~~~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.
REQUIRED (MUST be completed)
CONDITIONAL (MUST be completed when required by ITEM DEFINITION)
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:
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I o<UOS :3!1 _ _ , ___ ,! ___ _ ~ __ J_~_.J _______ - - -----------~
~-~-Df 1-n--~-.w1-a; 1-n--- -----------·---~
REQUIRED (MUST be completed)
0 CONDITIONAL (MUST be completed when required by ITEM DEFINITION)
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3 .117.1 (Rev. 08/96)
LINES 8 -9 ITEMS:
960 Corrected Transaction Identifier
LINE 1 0 .REMARKS AND BACKUP INFORMATION:
Refer to PAM pages 2.201 - 2.205 for specific substantiation required on:
1 - Bilingual Payment Authorization (Item 351).
3: ....... (I) () ['11
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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(
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11! , .. 10:
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tu: ·~:-::.~ . •.· .:•
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~~~~...::~ . ' ' . ' . . . , .. ~ .. , - . ·- 0.'1 • oOJOa ----- ~ ---- ~-- -- -~L--- f- --.J. -- __ .... __ _ "' ' ' ' . c.oa
ITo: . ' -----.L----.J--- ' ' ' ' ' ' ' . ' ~·--- ---- -- --~-- - --:---- ~- - --~-- -- -:- --- 0 "'' . ' . ' . ' . . ' ' ' . ' .
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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.
REQUIRED (MUST be completed)
0 CONDITIONAL (MUST be completed when required by ITEM DEFINITION)
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
960 Corrected Transaction Identifier
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.
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1 TO:
2 TO:
'
3 TO:
3.122 (Rev. 05/88)
430 PROBATIONARY PERIOD *1
$OC.IAf.. SI(CA.A1' T •
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606 0A.S I r()U't:S I o-C)fH _,, OA$ 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.
REQUIRED (MUST be completed)
CONDITIONAL
*2 •
•
(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 transaction)
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
(
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(
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3.123 (Rev. 05/88)
440 SEX
(CORRECTION OR CHANGE)
- .......a- _Q_ _D 0
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6 .... . .... J .. I lot ~ I h·- ... .._ ~ i•~·· -~ ~~ .. ; ~-- · ': -- - --'-- - .J ________ .Jl:f\. -- -----~--.J _________ ~ ~ ..-o ILG 0:1- . ..,..., ' "'"' . ' .
~; ~=====~:;::::::::::~: :: ::::~~~ :: ~:::::: . : ~ ' r tt _, ,,.... ,_
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7
*1 The current date must be used for Item 210 when reporting this transa cti on.
-
- 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 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
REQUIRED (MUST be completed)
CONDITIONAL (MUST be completed when required by ITEM DEFINITION)
• 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)
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 for a valid transaction)
3.126 (Rev. 05/88)
505 RETIREMENT SYSTEM INFORMATION*1
CCHANGE)
- •a..'<l ......... .. _Q_~_Q_
... OCJC&,.wft.lf"'OC(~~· 0
1 ITo:
wx,.... st:..Jit••. I ....... OTU ~4.!! .........C: I Ffii;S~ _.,. NC) ..::n.J ... , ..... ~..-· """ "' ~·· Ot~L -I ClXl 0 CDOl ..,.,(>, If''" OUT ... ,.
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4
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,. I I ' ' ' ' ' 6
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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)
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 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)
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-
I.M'tl ......
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REQUIRED (MUST be completed)
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)
. ··. . Ill•' COCl
ca
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...
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--0
REQUIRED (MUST be completed)
CONDITIONAL (MUST be completed when required by ITEM DEFINITION)
UNES 8- 9 ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed for a '!a lid transaction)
960 - Corrected Transaction Identifier
~"
'"'
.. ... ~ ..
I o<>J<\
'
ITEMS:
. .., , I . . .... ( ~ .....
f•-··o-. :,. . · ,
·~ .. ''i: ....... .......... . ~~~ · ......... :x :
,,.
1 046c37
! I
Fflm 3.130 (Rev. 05/88)
555 FINGERPRINTS
..!>OC-'- l/.:.J>"·. 1 TO.
2 ro: :~~ - "'~.
3 !To:1
::-:. ··-.;-::-, .~~
. . ]'~
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5 :To:l I "'"" .. ...
' I
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.,.,
0
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ru.....,,..... 7 TO·
... • •. w ..... • , __ _ __ l _ _ .J _ _ _ _ _ ::: ·~;~_:·-=---~--'----- ----~ , .. ~ .. 11 ......... ... ... !.. ...... ... ' ......... ...... ...... .. Jl:t\1 ......... ......... .. L ... ... J .. ....................... atD
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--0
REQUIRED (MUST be completed)
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)
960 Corrected Transaction Identifier
"''
..., c
I"'. )U :
..... ~ ., .. . 1,..
'"
ITEMS:
, ... --~
0 ..., . I
'-• •.f""i:. t•H-• ""'"' :• "1
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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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------- ____ _; ____ _:_ ___ ____ J _____ L___ " : : : : . ! I I I --- --'-----..1..--- t I
1 I I I I I I I • ------- ____ ..., ____ _.... ___ ----,.-----'---- 0 IVt I I I I , t I t I I f I t
I I I t I I I I
w:":. _.. , ..., to( 'Dot.! 1 ~ I IC- .0• 0ot.S I ~ I tC:""' .,, 17'!' Dol.! I OOCl.'.: I «-' ~ Ool..! I ~ I f'C'~ CX
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--0
REQUIRED (MUST .be completed)
CONDITIONAL (MUST be completed when requ ired by ITEM DEFINITION)
ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed for a valid transaction)
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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I I j~o ,. 0..,' • 0-0 • 1.., 0
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2 1 .. .._--n.o..,..n
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4
5
.I '~ ::~=-~6 ::OJ) ~ IV .. • AL-I:::a...:., ... ~ ..... ,;.. ,.c. ..--··""'<OJ' .- ..... ~ .. ~ro. . ,..,.. : c:,.. '~~ -. ·,~ . .,. 064 ... ~~ .. ....... at..:.
'01~:00 I I 0 0 I 0
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: *3: 0 I -----"---- ..1--- 0 0 I 0 • 0 0 0 0 0 0 I --·= ------- -- -..J--~-- ----~-----L.--- 0 M 0 I 0 . 0 0 . . I 0 0 I I I I 0
• 0 0 0 0 0 . I I 0
~....,- .X ~ I ~! I oCt oo c·a.:' ~'~ .. , UC o-J I fOJitS t ~ ~DoU · ~~ -c- "" ... ~ .. ... . ""
6
- ' . o . M ~
" __ _ __ t, __ .J ___ ::::_ ;...:·~~::_"'7.._.J ______ ---~ ~~~ .. ~~ . --:;-~ .. ~ ~-~· TO:I ""'
....... 0 .. "' -0 0 n -----L---'--------~-------L--J--------- IIfl:\ 0 0
~:,~- - - --!..-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
960 - Corrected Transaction Identifier
LINE 10 REMARKS AND BACKUP INFORMATION:
1046c41
3. 134 (Rev. 05/88)
705 TOTAL STATE SERVICE (CHANGE)
0 I ' ' ' ' ' ... I
1'016'f0. IIIU4If•
aa<' ! vr : cuss
1 )': 11 ' 1/J
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*l The current date may be used for Item 210 when reporting this transaction.
--0
REQUIRED (MUST be completed)
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)
ONE OR MORE REQUIRED (ONE or MORE of these items on this chart MUST be completed for a valid transaction)
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
960 - Corrected Transaction Identifier
.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
(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 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.
REQUIRED (MUST be completed)
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
: .:
LINE 10 REMARKS AND BACKUP INFORMATION:
( \
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)
0 CONDITIONAL (MUST be completed when required by ITEM DEFINITION)
-- 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)
CONDITIONAL (MUST be completed when required by ITEM DEFINITION)
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,.,.
REQUIRED (MUST be completed)
b) to correct the SAL when Reconstructing Employment History regardless of the effective date.
0 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 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
LINE 10 REMARKS AND BACKUP INFORMATION:
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-
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* 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.}
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104 6c60/0072
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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.
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3.152 (Rev. 11197)
SPC SPECIAL CHANGE * 1
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I • Eligibility for NDI benefits when employee is not on NOI Leave (S49) status.
REQUIRED (MUST be completed)
CONDITIONAL (MUST be completed when required by ITEM DEFINITION)
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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