KRONOS SUNY Upstate Medical University
Payroll Services
HISTORICAL CORRECTION Jacobsen Hall, Room 100
Phone: 315-464-4840
FORM
Fax: 315-464-6337
www.upstate.edu/payroll
The purpose of this form is to request a correction to a previously approved and signed off time record in the
Kronos system. All pay related changes will be processed for the next available paycheck. If there is a more urgent
need, please call the Payroll Services Office at 464-4840 (State) or 464-6350 (Research Foundation).
SECTION I: CORRECTION TO BE MADE
Emp ID#: Employee Name:
Home
Department #:
Department:
Date of Occurrence Type of Time/Pay Due to Amount Due in
(Historical Date) : Employee (Pay Code): Hours(HH.hh):
Reason for Correction/
Additional Comments:
If Applicable:
Transfer to Transfer Dept
Dept #: Name:
SECTION II: EMPLOYEE SIGNATURE
Employee- By signing below, I agree to have Payroll adjust my time/paycheck for the above requested change to a previously
approved and signed off time record.
Employee Date
Signature:
SECTION III: SUPERVISOR/MANAGER SIGNATURE
Supervisor/Manager - By signing below, I approve the above change to the listed employee's time record and agree to have
Payroll adjust the employee's time/paycheck for this adjustment to a previously approved and signed off time record.
Supervisor Name
Supervisor ID#:
(please print:
Supervisor Date
Signature:
FOR PAYROLL SERVICES USE ONLY:
Print Form
Initials of Processor:
Please complete, sign and return to:
Payroll Services
Date Processed:
Jacobsen Hall, Room 100.