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 30.

Using Firefox with PDF forms?

Make Adobe Acrobat the reader.

Competing 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 30

Need Help Completing the Form?

Send email, phone or submit a question

Changing the Pay Option

Sharon Holdsworth

State Workforce Planning and Recruitment

Phone: 716-645-4434

Email: sah@buffalo.edu

Leave or Benefit Coverage

Claudia Samulski

State Benefit Services

Phone: 716-645-4487

Email: samulski@buffalo.edu

Payroll Questions

Dana Moore

Manager

State Payroll and Appointment Processing

Phone: 716-645-8157

Email: dlmoore@buffalo.edu

About the Issue or Your Comments

 
 
(We'd like to respond to you.)
(Required)

Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: 4/2017

Owner: Human Resources