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Faculty and Staff Forms

Deferred Compensation Program - 457
The Deferred Compensation Plan is a supplemental retirement savings program authorized under Section 457 of the Internal Revenue Code.
Direct DepositDocument icon
Please include a voided check with the direct deposit application
Dual Compensation FormDocument icon
Request Form for Dual Employment
Employee's Nonwithholding Application CertificateDocument icon
Application for exemption of withholding of Pennsylvania state tax.  Residents of Indiana, Maryland, New Jersey, Ohio, Virginia or West Virginia should complete this form to have tax withheld for his/her state of residence.
Faculty Pay Schedule for 2016-2017Document icon
Faculty pay schedule for academic year 2016-2017.
I-9 for 2017Document icon
2017 I-9 form to be completed for employment.  Needs to be submitted to the Payroll Office.
Local Services Tax - Exemption Certificate - 2017Document icon
Tax Year Application for Exemption from Local Services Tax
Manager Working From Home Reporting FormDocument icon
Time Reporting form for managers working from home (Excel)
Meal Reimbursement Request FormDocument icon
Form for employees to complete to request meal reimbursement.
PASSHE 2017 Paydays and HolidaysDocument icon
PASSHE Calendar showing 2017 Paydays and Holidays
Residency Certification Form: Change of AddressDocument icon
This form is to be used by employers and/or taxpayers to report essential information for the collection and distribution of Local Earned Income Taxes.
Savings Bond FormDocument icon
Savings Bond direct deposit authorization form
SCUPA (Full-Time) Time and Attendance FormDocument icon
Time sheet for full-time SCUPA employees
SCUPA (Part-Time) Time and Attendance SheetDocument icon
Time sheet for part-time SCUPA employees
Statement Of Citizenship StatusDocument icon
Please fill this form out yearly if you are a nonresident alien.
TAPpayrdeduction-07Document icon
Payroll deductions for TAP college savings plan
Tax-Sheltered Annuity Plans - 403(b)
Information on tax-sheltered annuity plans 403(b).
Time and AttendanceDocument icon
Time and Attendance Form
Withdrawal of Consent to Electronic W-2Document icon
Use this form only if you have consented to electronic-only delivery of your W-2 but have changed your mind and now want the State System to send your W-2 via U.S. mail.
W-4 for 2016Document icon
Form W-4, ensures your employer can withhold the correct income tax from your pay
  • Payroll Services Office
  • Sutton Hall, Room G11
    1011 South Drive
    Indiana, PA 15705
  • Phone: 724-357-2510
  • Fax: 724-357-7551
  • Office Hours
  • Monday through Friday
  • 8:00 a.m.–4:30 p.m.