Payroll Forms

See below for instructions for completing fillable and Excel version forms.

• AC 230 – Report of Check Returned for Refund or Exchange (Fillable PDF) (Excel)
• AC 873 – Extra Service Payroll Voucher (Fillable PDF)
• AC 934-P – Next of Kin Affidavit for Bureau of State Payroll Services (Fillable PDF) (PDF)
• AC 1394 – Application & Account for Partial Payment of Salary (PDF)
• AC 1476-P – Report of Check Exchange (Fillable PDF)
• AC 1588 – Dual Employment/Extra Service Approval Form (Fillable PDF)
• AC 1767 – TIAA Action Request (Fillable PDF)
• AC 2674 – W-2 Correction Worksheet (Fillable PDF)
• AC 2714 – Undeliverable Payroll Check Report (Word) (Fillable PDF)
• AC 2822 – Bureau of State Payroll Services Payroll Transaction Authorization Form (Fillable PDF)
• AC 3173 – Agency Report of Taxable Value of Personal Use of an Employer-Provided Vehicle (Fillable PDF) (PDF)
• AC 3197 – Fax Request for Direct Deposit Stop/Reversal (Fillable PDF)
• AC 3202 – Payroll Certification Form (Fillable PDF)
• AC 3206 – Prior Year Social Security and Medicare Tax Refund Certification - CUNY (Fillable PDF) (PDF)
• AC 3206 – Prior Year Social Security and Medicare Tax Refund Certification - NYS (Fillable PDF) (PDF)
• AC 3300-S – Certification for Payment of Pre-Adjudicatory Settlement Agreements (Fillable PDF)
• Direct Deposit Form and Information
  • AC 2772 – Direct Deposit Form
  • Guide to Completing AC 2772 Direct Deposit Form
  • Direct Deposit: Make It Easy On Yourself!
• Personal Privacy Protection Law Release Forms and Instructions
  • Personal Privacy Protection Law Release Form Instructions
  • Personal Privacy Protection Law Release Form – AC 3216
  • Personal Privacy Protection Law Release Form – For Garnishment Deductions only.
• Position Data Request Forms
  • Extra Service Position Data Request Form – AC 3217 (Fillable PDF) (Excel)
  • NYS Position Data Request Form – AC 3218 (Fillable PDF)
  • Position Data Request Form – AC 3219 (Fillable PDF) (Excel)
• SUNY Charitable Giving Campaign Form
  • SUNY Charitable Giving Campaign Payroll Deduction Form

Fillable PDF

To view, complete and print the fillable forms, you will need the Adobe Acrobat Reader software installed on your computer. This software does not allow you to save your completed or partially completed form to a disk or on your computer.

• After opening the form, position the hand pointer inside a field and click. The I-beam pointer allows you to type text.
• To go to the next field, press Tab or use your mouse to click on the next field.
• To go to a previous field, press Shift + Tab or use your mouse to click on the previous field.
• After completing the form, print the fillable form.

Excel 

The form should be saved to the user's computer for completion and then submitted as instructed.