Payroll Forms

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

• AC 230 - Report of Check Returned for Refund or Exchange (Excel) (Fillable)
• AC 873 - Extra Service Payroll Voucher (Fillable)
• AC 934-P - Next of Kin Affidavit for Bureau of State Payroll Services (print) (fillable)
• AC 1394 - Application & Account for Partial Payment of Salary (Print only)
• AC 1476 P - Report of Check Exchange (Fillable)
• AC 1588 - Dual Employment/Extra Service Approval Form
• AC 1767 - TIAA Action Request
• AC 2674 - W-2 Correction Worksheet (Fillable)
• AC 2714 - Undeliverable Payroll Check Report (Word template ) (Fillable)
• AC 2822 - Bureau of State Payroll Services Payroll Transaction Authorization Form (Fillable)
• AC 3173 - Agency Report of Taxable Value of Personal Use of an Employer-Provided Vehicle (Fillable)
• AC 3197 - Fax Request for Direct Deposit Stop/Reversal (Fillable)
• AC 3202 - Payroll Certification Form (Fillable)
• AC 3206 - Prior Year Social Security and Medicare Tax Refund Certification (CUNY) (Fillable) (PDF)
• AC 3206 - Prior Year Social Security and Medicare Tax Refund Certification NYS (Fillable) (PDF)
• AC 3300-S - Certification for Payment of Pre-Adjudicatory Settlement Agreements
• AC-3340 - Application by Payee or Agency Representative for Issuance of Replacement Check (Fillable)
• 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 (Excel) (Fillable)
  • NYS Position Data Request Form - AC 3218 (Fillable)
  • Position Data Request Form - AC 3219 (Excel) (Fillable)
• SUNY Charitable Giving Campaign Form
  • SUNY Charitable Giving Campaign Payroll Deduction Form

Fillable

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.