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Overpayment Notification Email this form along with the a copy of the departments correspondence to the employee to: payforms@umn.edu
U Wide Form:
October 2025
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Enter the appropriate information in the Blue Fields
Orange Fields contain Drop Down Lists - Select the appropropriate information
ALL Blue and Orange Fields mustbe completed - If not the form will be Returned
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Employee NameEmployee ID
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Employee's Home Address Record #Note : This is the record the overpayment occurred on
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ALL Employee's Email AddressesCompany/Pay Group
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Employee Status:
Temination Date:
Does an Active Record Exist?
If yes, Active Record #
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Dept # Description ZDEPT IDZDEPT ID Description College ID
College Description
If Active Employee - Did EE sign the Consent form?
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#N/A#N/A#N/A#N/A#N/AIf EE has signed the Consent Form - attach consent to this form
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Reason for Overpayment
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Additional Required Information for Overpayments on Sponsored Projects
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Sponsored Combo Code
(Account Paid On)
Moved to Non-sponsored Combo Code
Moved to Non-Sponsored Chart String - Dept ID - Program – Project – Fin Empl ID – CF1 - CF2 - Account #
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Overpayment (List only the overpaid gross amounts – See instructions)
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Pay Period End Date (Oldest to Newest)Chart String for Credit Correction
(Fund, Dept ID, Program #, Account #)
Limited to 1 Chart String 		Combo code associated with Chart String
Limited to 1 Combo Code		Earnings Code Overpaid Hrs Hourly Rate Overpaid Amount
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Prepared By:
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Phone/Email Address
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Department Authorized Signature
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Attach copy of correspondence to the employee concerning the overpayment AND Consent to Collection of Overpayment form. (The Consent to Collection of Overpayment is only needed when the overpayment is deducted from a future pay) If the employee has terminated, Payroll Services will contact the former employee regarding the repayment method.
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The University of Minnesota is an equal opportunity educator and employer.
 2011 by Regents of the University of Minnesota.
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