ࡱ> <>;G  bjbjَ 5]4$$| .Fe)d       $2 &7 E"7 ! .! ! !   ! !    39 UW Extension Inter-Institutional Employment Overload Request Form for Unclassified Employees An UW-Extension Inter-Institutional overload payment requirement occurs when an individual holding an appointment at another UW institution (Institution A) exceeds 100% employment by providing services to an UW-Extension department. Prior approval by both institutions is required for services that exceed $1,000 or services that are recurring. UW-Extension prepares the Inter-Institutional Employment Overlaod Request Form and forwards to institution A to review. If both institutions approve, UW-Extension establishes a separate appointment position title and pays the employee on the UW Processing Center End-of-Month payroll. For non-recurring services that are less than $1,000, UW-Extension prepares an Additional Instruction Appointment Form and payrolls the employee directly on the UW Processing Center End-of-Month payroll. No overload approval is required. PLEASE NOTE: If UW-Extension intends to transfer funds to Institution A as a part-of-load payment for the employee's services, an Inter-Institutional Agreement (IIA) should be processed using an Inter-Institutional Agreement (IIA) Form, not an Inter-Institutional Employment Overload Request Form. Employee Information: Employee's Name:  FORMTEXT       Social Security Number:  FORMTEXT ###-##-#### Institution A:  FORMTEXT       UDDS (Dept Code):  FORMTEXT       Total % Time:  FORMTEXT       Current Salary and Basis:  FORMTEXT       Current Title:  FORMTEXT       Current Salary and Basis:  FORMTEXT       Current Title:  FORMTEXT       Proposed Overload Payment by UW-Extension: Division:  FORMTEXT       Department:  FORMTEXT       Proposed Title:  FORMTEXT       % Time (if applicable):  FORMTEXT       Description of Duties:  FORMTEXT       Duration of Overload Assignment: (Start Date)  FORMTEXT MM/DD/YY (End Date)  FORMTEXT MM/DD/YY Total Excepted Payment for Overload Assignment: $ FORMTEXT       Appointment No.  FORMTEXT       Charge to:  FORMTEXT Fund  FORMTEXT Acct  FORMTEXT Unit  FORMTEXT Div  FORMTEXT Dept  FORMTEXT Act Payment Procedure:  FORMCHECKBOX  Lump sum payable after appointment end date.  FORMCHECKBOX  Department certification required. Previous Inter-Institutional Overload Payment From UW-Extension: (Employee completes this section) List all Inter-Institutional Overloads paid beginning January 1 of current year (this includes December end-of-month payroll of previous calendar year): (Wis. Stats. 16.417(2) limits overloads to $12,000 paid in a calendar year from each state agency of UW System institution. Failure to count all overloads may result in an overpayment violating state law and may require the employee to forfeit earnings in excess of $12,000.) I acknowledge the $12,000 overload limit from any UW Institution (Employee's Signature of Acknowledgement) Date: Date: Date: Compensation: Compensation: Compensation: Overload Approval: UW-Extension: Date: (Department Chair/Supervisor) Date: (Dean/Director) Date: (Vice Chancellor or Designee) Institution A: Date: (Department Chair/Supervisor) Date: (Dean/Director) Date: (Vice Chancellor or Designee) Return completed form to: UW-Extension Dept. 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