PRINT
CODE REQUEST FORM
Use this form to add an existing pay code to a benefit package (Section B), or to request a
new code for work schedules (Section A). For new garnishment codes, please use form
OSPS.99.33 – Garnishment Code Request Form.
Section A: Work Schedule Code Request
(or
N/A)
Pre-request agency checklist:
Part-time schedule converted to full-time equivalent (4 hrs @ 50% equals 8 hrs f/t)
OREGON STATEWIDE
Daily hours converted to xx.x format (10.25 becomes 10.2 or 10.3)
PAYROLL SERVICES
(OSPS)
Database / publications searched for existing code (full-time equivalent)
(503) 378-3518 fax
1
Sun
Mon
Tues
Wed
Thurs
Fri
Sat
Total
Week 1:
E-mail:
OSPS.Help@oregon.gov
Begin Date
Sun
Mon
Tues
Wed
Thurs
Fri
Sat
Week 2:
Online Resource Center:
http://go.usa.gov/bEJk
1- Must total 40 hours for a one-week schedule, or 80 hours for a two-week schedule
INSTRUCTIONS TO
PAYROLL OFFICES:
This code is for a part-time person and will not be used for a full-time schedule.
Complete this form online
at
http://go.usa.gov/BVNG
Checking this box restricts this code to your agency only. Your agency acknowledges the
potential for FLSA violation if used on a full-time employee.
1. Verify all required fields
are complete.
2. Ensure your agency
number appears on the
2
Section B: Add Existing
Pay Code to Benefit Package
(or
N/A)
form.
Limitation: No codes are added on the
Pay Code
Benefit Pkg
Pay Period Start
3. Submit electronically
two days between prelim and final payroll
(Current / Future Month Only)
using the email submit
cutoffs twice a month.
button.
Authority
Citation
(Article/Policy #, Section)
____________________
Example: Article 11.5.1
Statewide HR Policy
Relevant Language
CBA with union/local:
_____________________
Agency Policy – submit copy to
OSPS with request
2- If you do not find an existing code to fit your need, contact OSPS to begin the new code request process.
Section C: Submitted By
OSPS Use Only
I certify that this request fully complies with the applicable collective bargaining agreement,
Received Date Stamp
statewide HR policy, or agency policy. In the event of an audit, I can fully support this
request with internal documentation.
Use your signature for print version, or email address for electronic submission.
Submit by Email
Agency #:
Signature/Email ______________________________________________________________
Printed Name:
Date:
For OSPS Use Only
Revised 02/2016
 Citation Verified or  N/A
 Database Updated or  N/A
 Code Issued: ________
Form No. OSPS.99.27
PRINT
CODE REQUEST FORM
Use this form to add an existing pay code to a benefit package (Section B), or to request a
new code for work schedules (Section A). For new garnishment codes, please use form
OSPS.99.33 – Garnishment Code Request Form.
Section A: Work Schedule Code Request
(or
N/A)
Pre-request agency checklist:
Part-time schedule converted to full-time equivalent (4 hrs @ 50% equals 8 hrs f/t)
OREGON STATEWIDE
Daily hours converted to xx.x format (10.25 becomes 10.2 or 10.3)
PAYROLL SERVICES
(OSPS)
Database / publications searched for existing code (full-time equivalent)
(503) 378-3518 fax
1
Sun
Mon
Tues
Wed
Thurs
Fri
Sat
Total
Week 1:
E-mail:
OSPS.Help@oregon.gov
Begin Date
Sun
Mon
Tues
Wed
Thurs
Fri
Sat
Week 2:
Online Resource Center:
http://go.usa.gov/bEJk
1- Must total 40 hours for a one-week schedule, or 80 hours for a two-week schedule
INSTRUCTIONS TO
PAYROLL OFFICES:
This code is for a part-time person and will not be used for a full-time schedule.
Complete this form online
at
http://go.usa.gov/BVNG
Checking this box restricts this code to your agency only. Your agency acknowledges the
potential for FLSA violation if used on a full-time employee.
1. Verify all required fields
are complete.
2. Ensure your agency
number appears on the
2
Section B: Add Existing
Pay Code to Benefit Package
(or
N/A)
form.
Limitation: No codes are added on the
Pay Code
Benefit Pkg
Pay Period Start
3. Submit electronically
two days between prelim and final payroll
(Current / Future Month Only)
using the email submit
cutoffs twice a month.
button.
Authority
Citation
(Article/Policy #, Section)
____________________
Example: Article 11.5.1
Statewide HR Policy
Relevant Language
CBA with union/local:
_____________________
Agency Policy – submit copy to
OSPS with request
2- If you do not find an existing code to fit your need, contact OSPS to begin the new code request process.
Section C: Submitted By
OSPS Use Only
I certify that this request fully complies with the applicable collective bargaining agreement,
Received Date Stamp
statewide HR policy, or agency policy. In the event of an audit, I can fully support this
request with internal documentation.
Use your signature for print version, or email address for electronic submission.
Submit by Email
Agency #:
Signature/Email ______________________________________________________________
Printed Name:
Date:
For OSPS Use Only
Revised 02/2016
 Citation Verified or  N/A
 Database Updated or  N/A
 Code Issued: ________
Form No. OSPS.99.27
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