Non-Salary Compensation Form
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1Non-Salary Compensation Form
Use this form for all items covered by
NCSU Policy
05.15.03, Non-Salary and Deferred Compensation . Item must be authorized in
advance and must be paid from non-state appropriated funds in accordance with policy.
College/Division
Employee ID
Department/Unit
First Name
Middle Initial
Last Name
Employee Title
Position Number
EPA
SPA
Value Basis:
Value of Non-Salary Compensation Item
Total (one-time, non-recurring)
Approximate/Estimated
Actual/Exactly
Per Month
for ______(#) Months
Per Month, Ongoing
Anticipated Date(s)
Per Year, Ongoing
Start
Stop
NA
Other
Type of Non-Salary Compensation (check one)
Details/Specifics about the item to be provided
Household Moving Expenses
House-Hunting Expenses
Temporary Housing
Funding Source
Vehicle & Parking Costs
This Item (check one)
i
NCSU
s pre-authorized for this type of position under provisions of
Club Membership
Policy 05.15.03
.
Athletic & Cultural Events Admission
requires approval by the Board of Trustees, in accordance with
NCSU
Product or Service Discount > 20% off retail and/
Policy 05.15.03.
Submit completed form by
BOT submission deadline
to
or not provided to all University employees
Director, EPA Administration, Campus Box 7563.
If paid by voucher through Financials, attach copy of this signed
Other
form to the invoice package.
Form completed by
Date
Title
Phone Number
Email
Department Head Approval
Print Name
Signature
Date
Dean or AVC Approval
Signature
Date
Print Name
Chancellor Approval (if BOT approval required)
Signature
Date
Board of Trustees (UAC) Action
HR USE ONLY (notes)
Approved
Date
Denied
Questions about this form? Contact the Payroll Tax Manager @ 515-2062
Page 1 of 1
Revised: 06/14/2011
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Parent category: Legal