Revised Payroll Correction Payment Request Form

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The Division of Personnel has revised the Payroll Correction Payment Request Form (PAYC), effective September 15, 2022. The revised form may be used for payment of back wages owed due to reallocation, salary adjustment, or resulting from verified work time which was not paid that has occurred within the last twelve (12) months AND under $5000.

The PAYC Form may also be used when restoring annual leave and/or back wages owed following a non-disciplinary suspension in accordance with the DOP Administrative Rule. Restoration of annual leave and/or back wages owed following a non-disciplinary suspension are not subject to the twelve (12) month/$5000 cap.

The form may not be used when a former employee is being reinstated from a dismissal, resignation in lieu of dismissal, for payment of back wages for exempt and temporary employment, or when applicants work prior to appropriate approvals for employment or promotion.

The PAYC Form is available on the DOP website under Settlement Agreement Samples and Forms, under the Forms/Documents tab.

Should you have any questions, please contact the Employee Relations Section at 304-414-1853. ​

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