Payroll Forms

The Library of Virginia records retention schedule for state agencies requires payroll forms to be retained 5 years after the end of state fiscal year end (effective 8/2012)


MyTime Supervisor Request Form

The MyTime Supervisor Request Form is used to request specific leave to the employee or to request a permanent change to the employees lunch break within MyTime.  The effective date of the leave or lunch hour change will be reflected within MyTime  by the  Effective Date indicated on the form.

Supporting documentation is required for all leave categories and must be received in Payroll prior to the granting of leave.

Leave categories included on this form are those for: Bone Marrow, Disaster, Education, Jury-Civil Work Related, Military and Public Health Emergency.

Supporting Policy Documentation

MyTime Payroll Adjustment Request Form

The MyTime Payroll Adjustment Request Form is used to request an adjustment to an employee’s timecard for a pay period that has been Signed Off (finalized) by Payroll.  Changes to a Signed Off pay period require Payroll to perform a manual edit to the employee’s historical record. The supervisor must  provide sufficient documentation to support the manual change, listing specific dates and times to be corrected, and provide an  explanation of why the errors to the employee’s time card were not corrected prior to the Approval deadline. The employee and their supervisor must sign this form. Please submit the completed form directly to the Payroll Office.

Alternate Pay

Request for Special Payment of Teaching and Administrative Faculty- In the event that Teaching and Administrative Faculty perform services for the University outside the scope of their regular full-time employment, they may be eligible for an additional, special payment.  The completed form is signed by all appropriate staff members and forwarded to Human Resources for final approval.  Classified staff and Wage employees may not be paid with this form.

Effective May 1, 2013 – *Note on Adjuncts: To assure compliance with the state’s Affordable Care Act guidance, Deans must determine and approve the additional hours of work before assignments are made. Any hours of work compensated by a special pay action will have to be documented and counted towards their 29 hours per week on average over a twelve month period.

Direct Deposit

Direct Deposit Form – The Commonwealth of Virginia requires state employees to receive their pay electronically, by direct deposit to a checking or savings account or by deposit to a debit card.  Enter your banking information on this form and return it by mail to Payroll with the required signatures or attachments.  Do not send direct deposit information by email.  It is against UMW policy to send sensitive data by email.  Please allow two weeks for changes to direct deposit information to become effective.  If the direct deposit form is being mailed to Payroll, please contact Payroll at x1180 to confirm its receipt

Tax Forms

VA Tax Form VA-4 – Use this form to notify Payroll whether you are subject to Virginia income tax withholding and how many exemptions you are allowed to claim. You must file this form with Payroll when your employment begins. Employees claiming exempt from VA taxes must file a new VA-4 form each year.

Federal Tax Form W-4 (2015) – This form is completed when your employment begins so the Payroll Office can withhold the correct federal income tax from your pay. The IRS recommends you consider completing a new Form W-4 when your personal or financial situation changes. Employees claiming exempt from federal withholding must complete a new W-4 form each year.

Tax Sheltered Annuity (TSA) Administrative Services

Cash Match Agreement FormEligible employees complete this form to participate in the Commonwealth’s Cash Match Program. Employees may receive a matching contribution to their Deferred Compensation Plan (“DCP”) or Supplemental Retirement Annuity Plan (“SRA”).

403(b) SRA Form
– This form authorizes the Payroll Office to defer a portion of the employee’s compensation to a 403(b) investment program. Employees
complete this form to notify Payroll of the amount per pay they chose to be deferred.

Other Forms

EagleOne Payroll DeductionEmployees may complete this form to have a prescribed amount automatically deducted from each pay and applied to their Eagle One account.

Housekeeping Stipend Eligibility Requirements – Eligible UMW Housekeeping employees should complete this form to receive a stipend for personal vehicle use. Please refer to the Housekeeping Stipend Procedure for eligibility standards.

Sickness & Disability Election for University & Administrative Faculty – Faculty who have chosen the Virginia Retirement System as their pension plan should use this form to selection their disability preference within 60 days of hire.