Form PAY-23A "Notification of Agency's Payroll Center (Regarding a Request to Use Catastrophic Leave)" - Nevada

Form PAY-23A Printable Pdf
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What Is Form PAY-23A?

This is a legal form that was released by the Nevada Department of Administration - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 8, 2010;
  • The latest edition provided by the Nevada Department of Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form PAY-23A by clicking the link below or browse more documents and templates provided by the Nevada Department of Administration.

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Download Form PAY-23A "Notification of Agency's Payroll Center (Regarding a Request to Use Catastrophic Leave)" - Nevada

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NOTIFICATION OF AGENCY’S PAYROLL CENTER
(REGARDING A REQUEST TO USE CATASTROPHIC LEAVE)
(Per NRS 284.362)
To be completed by person requesting leave or his/her immediate supervisor.
BUDGET ACCOUNT #:
REQUESTOR
: (Please print or type)
NAME:
EMPLOYEE ID#:
TITLE:
CLASS CODE:
GRADE:
HOURLY RATE:
DEPARTMENT:
DIVISION:
CATASTROPHIC LEAVE BEGINNING DATE: ___________________________
(This date should be the same as the Catastrophic Leave Beginning Date
found in Section I, Number 3 of the PAY-23 form. The appointing authority
has the authority to modify this date when approving this form)
NUMBER OF HOURS APPROVED: ___________________________
TRANSFER
HOURS FROM THE GENERAL CATASTROPHIC LEAVE ACCOUNT.
TRANSFER
HOURS FROM THE CATASTROPHIC LEAVE ACCOUNT, WHICH WERE SPECIFICALLY
ALLOCATED FOR USE BY THE REQUESTOR.
Pursuant to NRS 284.3622, the maximum number of hours that may be transferred to an employee is 1,040 in any one calendar year.
__________________________________________
Requestor Signature
Date
*****************************************************************************************************************
SUPERVISORY APPROVAL
: (CHECK ONE)
YES
NO
__________________________________________
Signature of Immediate Supervisor
Date
*****************************************************************************************************************
APPOINTING AUTHORITY
: (CHECK ONE)
YES
NO
_________________________________________________________
__________________________________________
Signature and Title of Appointing Authority
Date
Distribution:
Appointing Authority
Agency Payroll Clerk
Employee
PAY-23A
Rev. 06/08/2010
NOTIFICATION OF AGENCY’S PAYROLL CENTER
(REGARDING A REQUEST TO USE CATASTROPHIC LEAVE)
(Per NRS 284.362)
To be completed by person requesting leave or his/her immediate supervisor.
BUDGET ACCOUNT #:
REQUESTOR
: (Please print or type)
NAME:
EMPLOYEE ID#:
TITLE:
CLASS CODE:
GRADE:
HOURLY RATE:
DEPARTMENT:
DIVISION:
CATASTROPHIC LEAVE BEGINNING DATE: ___________________________
(This date should be the same as the Catastrophic Leave Beginning Date
found in Section I, Number 3 of the PAY-23 form. The appointing authority
has the authority to modify this date when approving this form)
NUMBER OF HOURS APPROVED: ___________________________
TRANSFER
HOURS FROM THE GENERAL CATASTROPHIC LEAVE ACCOUNT.
TRANSFER
HOURS FROM THE CATASTROPHIC LEAVE ACCOUNT, WHICH WERE SPECIFICALLY
ALLOCATED FOR USE BY THE REQUESTOR.
Pursuant to NRS 284.3622, the maximum number of hours that may be transferred to an employee is 1,040 in any one calendar year.
__________________________________________
Requestor Signature
Date
*****************************************************************************************************************
SUPERVISORY APPROVAL
: (CHECK ONE)
YES
NO
__________________________________________
Signature of Immediate Supervisor
Date
*****************************************************************************************************************
APPOINTING AUTHORITY
: (CHECK ONE)
YES
NO
_________________________________________________________
__________________________________________
Signature and Title of Appointing Authority
Date
Distribution:
Appointing Authority
Agency Payroll Clerk
Employee
PAY-23A
Rev. 06/08/2010
Nevada Department of Administration Nevada Legal Forms United States Legal Forms

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