Payroll Forms

Many forms listed on this page require the use of the Adobe Acrobat Reader 8.1.1.

If you have questions, concerns, or suggestions about any of these forms, call State Payroll
at 801-538-3056.

Payroll

• FI 6 – Retroactive Pay for Pay Rate Increase Worksheet
• FI 7 – Accepting Terms of Dual Employment
• FI 8 – Time Sheet for Dual Employment*
• FI 11 – Leave Bank Donation Request
• FI 13 – Immediate Replacement of Lost Payroll Check
• FI 15 – Payroll Warrant Request*
• FI 17 – Payroll System Leave Adjustment Form
• FI 18 – Retroactive Regular Pay Worksheet
• FI 19 – Retroactive Overtime Pay Worksheet
• FI 21 – Employee Authorization Agreement for Payroll Direct Deposits
• FI 22 – Request for Warrant to Replace Payroll Direct Deposit & Payroll Transactions
• FI 23 – Request for Pay Advance Payroll Deduction
• FI 24 – Workers' Compensation Adjustment Form
• FI 25 – Payroll Warrant Message Request
• FI 41 – Authorization for Voluntary Additional Utah Income Tax Withholding
• FI 46 – Retirement Worksheet Access Request Form
• FI 47 – Payroll System – Salary Splits
• FI 49 – Employee Self Service Request Form
• PYSA 1 – Payroll System Access Request Form