Pay Option Change Consent Form

State 10-month faculty submit this form consenting to change from a 21-pay period paycheck to a 26-pay period paycheck.  

Submit to your department head no later than June 28.

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Completing the PDF Form

  1. Print the form
  2. Complete requested information
  3. Sign form
  4. Scan a copy of the signed form for your records
  5. Send the original, completed, signed form to your department head by June 28

Need Help Completing the Form?

Changing the Pay Option

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Sharon Holdsworth

State Workforce Planning and Recruitment

Phone: 716-645-4434

Email: sah@buffalo.edu

Leave or Benefit Coverage

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UB HR Benefits

State Benefit Services

Phone: 716-645-7777

Email: ub-hr-benefits@buffalo.edu

Payroll Questions

Dana Moore.

Dana Moore

Manager

State Payroll and Appointment Processing

Phone: 716-645-8157

Email: dlmoore@buffalo.edu

Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: 3/2019

Owner: Human Resources