University of Virginia Time Management Form
Please COMPLETE ALL entries. INCOMPLETE FORMS WILL NOT BE PROCESSED.
Payroll Elements—Leave
Code
Code
Family Medical Leave (FMLA) Payroll Elements—Leave
*PLEASE CHECK ONE OF THE FOLLOWING (Required):
A
Annual Leave
FMF
FMLA Lv Family Member
[ ]
Original Submission - or -
FMLA leave is to be
AC
Agency Closing (Inclement Weather)
FMFN
FMLA Lv Family Mem No Lv
Correction Only (Complete as it should have been done
[ ]
keyed by the Departmental
BMOD Leave (Bone Marrow/Organ Donor)
BMOD
FMP
FMLA Lv Personal
circling corrections)
Timekeeper only.
C
Comp Leave
FMPN
FMLA Lv Personal No Lv
If this is a correction only, please choose one below:
CS
Comp Special Leave
[ ] Pay Adjustment Only
Short Term Disability and Workers Comp Leave Types
Comp Special Agency Closing (Enter for Exempt and
CSAC
[ ] Leave Adjustment Only
Workers Comp (Non-VSDP)
Non-exempt if employee works on Agency Closing day)
NWC
[ ] Both Pay and Leave Adjustment
STD (ORP)
Please note leave type, certify,
CSE
Comp Special Earned (Enter for Non-exempt who work on
OSTD
STD (VSDP)
and return to UHR Payroll.
their alternate work schedule day off)
VSTD
Code
Civil and Work-Related Payroll Elements—Leave
STD WC (VSDP)
STD/WC hours will not show
CSHW
Comp Special Holiday Worked (Enter for Exempt. For
VWC
AM
Civil and Work-Related Leave (Check VALID reason code
on timecard.
Non-exempt the system will automatically calculate)
below and attach supporting documentation as policy requires)
Educational Leave
E
FP
Family Personal Leave (VSDP)
Signatures certify this information is accurate and complete:
[ ]
Accompany Minor Child
FS
Family Sick Leave (Personal)*
[ ]
Administrative Summons
Holiday
H
Employee Certification
Career Services
[ ]
*Indicate relationship for absence
OL
Overtime Leave
Printed Name: ________________________________________________
[ ]
Employee Assistance Program (EAP)
required by illness or death in
MA
Military Active Duty
[ ]
Grievance Process
“immediate family” or “other
Military Physical
MP
Signature: ___________________________________ Date: ___________
Member of State Council, Commission, Board, Committee
[ ]
relative sharing employee’s home”:
RL
Recognition Leave
[ ]
Naturalization Ceremony
S
Sick Leave (Personal)
Supervisor Certification
[ ]
Subpoena for Witness or Victim
___________________________
School/Volunteer Leave
SL
Printed Name: ________________________________________________
Unemployment Compensation or Workers’ Compensation
[ ]
Relationship
UL
University Leave
[ ]
UVA Interview
VS
Sick Leave (VSDP)
Signature: ___________________________________ Date: ___________
AM-INT
Interview—Other State Agency
Department Certification
Code
Payroll Elements—Earnings
AM-JD
Jury Duty
Timekeeper Name: _____________________________________________
CBS
Call Back Supplemental (Enter for Non-exempt only)
AM-OE
Emergency Disaster Leave
HW
Hour Worked (Enter for Non-exempt only)
AM-OFE
Officer of Election
Timekeeper Extension: _________________________________________
Stand By (Enter for Non-exempt only)
SB
Organization: _______________________________ Assignment #: _______________ Payroll: Bi-weekly
Pay Period: Begin Date_____________ End Date ______________
Date
Code
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Total
Note: The deadline for all retroactive timecards is the Wednesday prior to the payroll processing week.
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