NYC Payroll Management System employee time report form

Z THE CITY OF NEW YORK -< z ■PAYROLL MANAGEMENT SYSTEM EMPLOYEE TIME REPORT o 5S

5o FISA FORM rtlSF 19|l2»q ADJUSTMENT -D c CT I o o'

□ o DOCUMENT NO. SOCIAL SECURITY NO. CO JSN WORK UNIT

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O1 CD O O I I I I I I ■a 13333 O 3. a> O O) LAST NAME FIRST o 11111111111 S33$EZ0 HIM o c 3o 2. TYPE 1 fczsa E^.TOATC ] I AGENCY REPORTING smarypiff. I I aiPPil [ ENTRY i PAY I I YEAR ] [ ENTRY TYPE EVERT TIME IEE3 J CATEGORY Bl DOLLARS I 1 CENTS I | PAVPP|

|oHll/M|o|/l i/|y|«i<>i 03133 033 0 o □ □ I »g»> I [3911331371 0333 133133 133 □n n □ 03132132 0333 0303 I 0 □ I I 03J22J33 0102 i^iyhioM I I 0 □ □ [old 1 02133133 0233 03133 I 0 n □ I NEW ] 021713071 17033 03133 I □ n □ □ I OLD ] 030302 0333 0303 ZED 0 n □ NEW ] 02031371 0222 03S3 rm 0 n □ PREPARER MANAGER/SUPERVtSOR KEY ENTRY OPERATOR * I CERTIFY THAT THE ABOVE ADJUSTMENTS ARE I CERTIFY THAT I HAVE THE ABOVE I CERTIFY THAT THE ABOVE DATE WAS ENTERED SU‘»PORTEDBY ITIONONFILE INTOPMS

SIGNATUtE SKMATURE StONATURE

DATE DATE DATE