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• Payroll Bulletins
• 2009 Payroll Calendar[PDF]
• 2009 Payroll Certification Schedule
• 2010 Payroll Calendar[PDF]
• 2010 Payroll Certification Schedule
• Payroll Operations Forms
• Third Party Admin (TPA)
• VSDP
• Workers Compensation Class Codes [PDF] [Excel]
• Payroll Service Bureau
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Payroll Operations Forms

DOA provides content in several formats that require plug-ins, or separate browser components, for proper viewing. Links to viewers, plug-ins and browser components are provided on our web policy page.

CIPPS Security Forms

• CIPPS Security Authorization Request Form [PDF] [Word]
• CIPPS FINDS Security Authorization Request Form [PDF] [Excel]
• CIPPS FINDS Security Form Instructions [PDF] [Word]

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Direct Deposit Forms

• Direct Deposit Authorization for Employees [PDF] [Word]
• Direct Deposit Stop Payment Form (PR-1) [PDF] [Word]

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Electronic Filing Forms

• Form 8655 - Reporting Agent Authorization for Magnetic Tape / Electronic Filers
  • Form only[PDF]
  • Instuctions only[PDF]
  • Form with Instructions[PDF]

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Healthcare Forms

• Healthcare Adjustments Worksheet [PDF] [Excel]
• Healthcare Certification Form[PDF]

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Leave Forms

• Leave Balance Spreadsheet [PDF] [Excel]
• L-1 - Leave Activity Reporting Form [PDF] [Word]
• L-2 - Leave Maintenance Form[PDF]
• L-3 - Leave Activity/Maintenance Batch Totals Form[PDF]
• L-4 - Leave Status Inquiry/Update Form [PDF] [Word]
• L-5 - General CIPPS Leave Information Form [PDF] [Word]

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Magnetic Media Forms

• Magnetic Media Requirements - 700 - Pay Transactions (Standard Time Reporting) [PDF]
• Magnetic Media Requirements - 8XX - Tax and Deduction Overrides [PDF]
• Magnetic Media Requirements - 9XX - Pay Transactions (Special Payments) [PDF]
• Magnetic Media Requirements - IBC - Batch Balance [PDF]
• Security Batch Transaction Request [PDF] [Word]

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Optional Group Life Forms

• Optional Life Premium Calculation Worksheet - VRS/Minnesota Life On-Line Forms

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Payline Forms

• Payline Agency Contact Form [PDF] [Word]
• Payline Security Authorization Request Form [PDF] [Word]

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Payroll Processing Forms

• Agency Authorization for Certification of Payrolls [PDF] [Excel]
• CIPPS Company Add/Maintenance (PR-12) [PDF] [Word]
• H0901 - Third Party Deduction Name and Address (PR-11) [PDF]
• HTM00 - Manual Pay/Earnings Update (PR-10.1) [PDF]
• HTMCK - Manual Pays 5 - Screenprint [PDF]
• HTMPA - Manual Pays 2 (PR-10.2) [PDF]
• HTMSP - Manual Pays 3 (PR-10.3) [PDF]
• HTMTD - Manual Pays 4 (PR-10.4) [PDF]
• HTODA - Deduction Refund/Adjustment (PR-7) [PDF]
• HTPSA - Employee Special Pay Adjustment (PR-6) [PDF]
• HTQTA - Tax Refund/Adjustment (PR-8) [PDF]
• HUA03 - Time and Attendance (PR-3) [PDF]
• HUC01 - Special Payment as Regular Pay (PR-4) [PDF]
• HUD01 - Deduction Override (PR-9) [PDF]
• HUE01 - Special Payments (PR-5) [PDF]
• Post Retirement Life Insurance Calculation Worksheet for ORP Retirees [Excel]
• U118 - Gross Pay Difference Explanation [PDF] [Excel]

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Quarterly Reconciliation Forms

• Quarterly Reconciliation - Employee File Adjustment Form [PDF]
• Quarterly Reconciliation and Certification Form [PDF]

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Statewide Deduction Forms

• Statewide Deduction Codes - Matrix of Deduction Codes [PDF]

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Statewide Special Pay Forms

• Statewide Special Pay Codes - Examples of Combinations of Indicators [PDF]
• Statewide Special Pay Codes - Matrix of Special Pay Codes [PDF]

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Third Pary Administrator Forms

• Cash Match Agreement Form [PDF]
• Flexible Reimbursement Account Election Form [PDF]
• Flexible Spending Account - Reimbursement Request Form [PDF]
• Post-Tax Salary Deduction Authorization [PDF]
• Pre-Tax Salary Reduction Agreement Form [PDF]
• TPA Employment Status Change Form [PDF]
• TPA Exception/Discrepancy Response Form [PDF]

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Void Forms

• Direct Deposit Stop Payment Form (PR-1) [PDF] [Word]
• Void Check Form (PR-2) [PDF]

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