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Pohnpei State Government
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Department of _________________________
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PositionOrg/Acct. Regular
Overtime
# ofOT 7.5% Employer Share
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Emp #NameTitleNumber Rate Rate
Hours
Date(s)
Reason for doing OT
OT Amt.SS Tax
Total Cost
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 $ - $ - $ - $ -
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 $ - $ - $ - $ - $ -
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 $ - $ - $ - $ - $ -
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 $ - $ - $ - $ - $ -
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 $ - $ - $ - $ - $ -
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 $ - $ - $ - $ - $ -
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0.00 $ - $ - $ -
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Funds Certification by:
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Prepared By:
Finance
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Name of Preparer, Title/Print & SignSIGNATURE
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Reviewed By:
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Name of Reviewer, Title/Print & Sign
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Approved By:
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Approving OfficialApproved by: DOTA
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