Form Osps.99.26 - Payroll Historic Record Access Request
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PAYROLL HISTORIC RECORD ACCESS REQUEST
Use this form to request access to the paper storage of old payroll records. These are
stored at the Records Center.
Section A: Choose Record Timeframe
Timeframe
Accession Numbers
7/1951 – 4/1961
79 A 112
OREGON STATEWIDE
5/1961 – 12/1976
95 RC 218 (79 A 113)
PAYROLL SERVICES
1/1977 – 12/1977
(OSPS)
95 RC 219 (83 A 16)
(503) 378-3518 fax
1/1978 – 9/1979
95 RC 220 (83 A 20)
E-mail:
OSPS.Help@oregon.gov
Section B: Agency Information
Agency #
Person(s) Viewing Records
Telephone Number
Online Resource Center:
Reason for Access
INSTRUCTIONS TO
PAYROLL OFFICES:
1. Complete this form
online at
Section C: Authorization
Please arrange access for the person(s) named in Section B to view the payroll records
2. Verify all required fields
selected in Section A.
are complete.
Use your signature for print version, or email address for electronic submission.
3. Ensure your agency
number appears on the
form.
Name:
Date:
4. Print form. Sign or initial
For OSPS Use Only
Submit by Email
and date where
Submit by Email
indicated.
5. Submit electronically
MEMO
using the email submit
button.
6. For Mac users: Print,
TO:
Archives Record Center
sign and fax completed
4298 22d Ave NE, Salem, Oregon
form to OSPS.
Phone: 503-373-1001
7. Once OSPS notifies you
FAX: 503-373-1051
that the Records Center
has been notified, call to
FROM:
Oregon Statewide Payroll Services Staff
arrange a time for
State Controller’s Division
viewing the reports.
Department of Administrative Services
RE:
PERMISSION TO ACCESS RECORDS
OSPS Use Only
Received Date Stamp
Please grant access to the record series selected in Section A to the agency and
staff outlined in Section B.
The agency will call you to arrange a time to view the records on site.
Thank you,
Signature:
Date:
OSPS Help Desk Staff
New 7/2016
Fax to Archives Notify Agency File in Yellow Agency Tie-Down Folders
Form No. OSPS.99.26
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