ADDITIONAL PAY FORM: REQUEST FOR ONE TIME OR RECURRING PAYMENT TO HARVARD EMPLOYEE

HUID FIRST NAME LAST NAME

DEPTARTMENT NAME

If the employee has more than one job at Harvard, provide the information for the position to which the payment(

s) best relates.

EARNINGS CODE *

SPECIAL PAYMENT

INSTRUCTION

DETAILED BUSINESS PURPOSE (attach supporting documents if needed)

attach additional pages when costing to four or more accounts)

TUB2

ORG2

TUB3

ORG3

GROSS UP

This form may be used to request a payment or create a record of additional income to a Harvard University Employee when the

requestor does not directly access PeopleSoft forms. The income may be a one-time or recurring payment or may be in the form of a

gift or payments to another entity on the employee's behalf. Contact the Employee's School/Tub level Human Resources, Payroll, or

Finance Office for instructions on how to complete and submit this form. Please type or print legibly.

Complete page 2 for EARNINGS CODEs GTP, GTX, MOV, MV3, MVI, MVN related to Employee Gifts and Moving & Recruiting Expenses to

be paid directly to a 3rd Party (a vendor or other employee).

Complete page 2 for explanation of NO CHECK REQUIRED (including LRB Add Pays related to Corporate Card Payments).

form reviewed June 2017 Page 1 of 2

PREPARER NAME & PHONE #

JOB CODE

Additional Department/Local Authorization if Required by School/Tub Guidelines (print, sign, and date)

or off-cycle payment date

*

*

To understand the requirements and tax implications for recording gifts, relocation expenses, and late reimbursements,

please see the University Financial Policies --Travel Policy, Business Expense Reimbursements Policy, and Employee Gifts and

NO CHECK REQUIRED

PAY TO (consult local HR or AP for preferred alternative methods)

PLEASE COMPLETE THIS SECTION IF A PAYMENT HAS ALREADY OCCURRED OR INCOME WILL BE RECEIVED BY OTHER MEANS. This

might have been payment to an outside entity or to another employee who made a purchase on behalf of employee named on this form, or

payment to employee named on this form prior to his/her start date. Please identify the payee and how payment was made (pCard, Corporate

Card, Payment Request#, etc.)? Also enter NO CHECK REQUIRED in the SPECIAL PAYMENT INSTRUCTION field on page 1 and provide supporting

documentation.

Name

Address1

Address2

Address1

Address2

Address3

City State Zip Code

HARVARD EMPLOYEE 3RD PARTY DETAILS (complete as fully as possible)

OR

form reviewed June 2017 Page 2 of 2

HUID

PREPARER: Complete page 1 (and page 2 if required) of this form to the best of your ability and consult with your local HR/Payroll expert

as needed. Submit to Department/Local Authorizing Signer along with all appropriate supporting documentation.