RENSSELAER Tenured/Tenure-Track Faculty and Non-Tenured Instructional Staff Supplemental Pay Authorization Form Position #: New RIN: Revised Log #: AY Salary Change ONLY 3 Work Dates: From: To: Current Fiscal Year Academic-Year Salary: 3 Next Fiscal Year Academic-Year Salary: Name: School: Maximum Summer: $ - Title: Dept: Grand Total (from allocation below): $ - 1 1 2 REASON CODES: A - Research/startup B - Administrative C1 - Base Overlead C2 - Summer Instruction D - Other Authorization Distribution and Payment Addition Reason Calculation /Change Code Fund Org Acct* Program Activity Method Payment % Description Pay Cycle #1: Start Date: End Date: - - - - - - - Total - 0.00% Pay Cycle #1: Start Date: End Date: - - - - - - - Total - 0.00% Pay Cycle #1: Start Date: End Date: - - - - - Total - 0.00% Pay Cycle #1: Start Date: End Date: - - - - - - - Total - 0.00% GRAND TOTAL - 1 Copy of appointment letter with specific details of startup or administrative supplement must be attached Additional Notes: 2 Attach a complete explanation and give reason for supplemental pay * 208 - Academic Year service * 208S - Summer Supplemental (5/16 - 8/15) Authorization prepared by (Please Print): Phone: Date: 5/15/2010 Signatures of Approval Required on All Requests: Department Head Portfolio Business Manager Vice Provost and Dean for Provost Office Business Manager Undergraduate Education (Summer Instruction Only) Additional Signatures of Approval Required for Code C1- (base overload only) and D: Academic Dean Provost Vice President for Human Resources 3 Additional Signature of Approval Required for AY Salary Change ONLY: Academic Dean Form revised 04/13/2010 Calculation Method: Show in Fractions* on Supplemental Form *Fraction of Academic Year Salary Credits Hours Weeks Desc 1/36 40 hours 1 Week 1/36 AY 1/27 1 Credit 53 hours 1/27 AY 1/18 80 hours 2 Weeks 1/18 AY 2/27 2 Credits 107 hours 2/27 AY 1/12 120 hours 3 Weeks 1/12 AY 1/9 3 Credits 160 hours 4 Weeks 1 Month 5/36 200 hours 5 Weeks 5/36 AY 4/27 4 Credits 210 hours 4/27 AY 1/6 240 hours 6 Weeks 1/6 AY 7/36 280 hours 7 Weeks 7/36 AY 2/9 320 hours 8 Weeks 2/9 AY 1/4 360 hours 9 Weeks 1/4 AY 5/18 400 hours 10 Weeks 5/8 AY 11/36 440 hours 11 Weeks 11/36 AY 1/3 480 hours 12 Weeks 1/3 AY 1/1440 1 Hour 2/1440 2 Hours 3/1440 3 Hours 4/1440 4 Hours 5/1440 5 Hours 6/1440 6 Hours 7/1440 7 Hours 8/1440 8 Hours AY Supl n/a Academic Year Suppelental Admin Supl n/a Administrative Supplemental OTC n/a Over the Cap D:\Docstoc\Working\pdf\19370d09-bcb7-4618-94a8-f86c40caacf3.xls 8/10/2011 pg 2 of 3 INSTRUCTIONS SUMMER SUPPLEMENTAL (208S) A faculty member may receive a maximum of 1/3 academic year salary as supplemental pay during the entire year (52 week period). Authorizations for summer supplemental payments must be properly routed and delivered to the Office of the Provost by May 1. Authorizations must be received at least four weeks prior to the applicable scheduled payment date. Payments for the summer will be from 5/31 - 8/15 (spread over 6 payments) unless otherwise indicated on this form. If paperwork is late, payments will be remitted retroactively. Failure to meet this schedule will result in the payment being delayed one pay period. The Faculty Supplemental Authorization Form should be used for changes to faculty pay only. Changes in FOAPA distribution should be made on a Planned Labor Distribution Change Form or changed through the labor redistribution process. Changes in total pay require a revised Supplemental Pay Form. For non-uniform payments and changes in payment amount, a spreadsheet detailing the information will need to be attached. Changes in academic year pay rate, effecting summer pay, need to be resubmitted on the Supplemental Pay Authorization Form. Only approval signatures from the Portfolio Business Manager and the Academic Dean are needed for AY pay rate changes. All other pay changes require approval per the Tenured/Tenure-Track Faculty and Non-Tenured Instruction Staff Supplemental Pay Policy. Labor is charged the following way: This authorization form acts as a direct charge. If a restricted fund is charged, a verification report will be issued to the employee at the end of the period/semester. The verification report must be signed and returned to the Controller’s Office to satisfy external audit requirements. If this report is not signed and returned, the charges will be transferred to the department.