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Currency [0]/Explanatory TextG5Explanatory Text % 0Good;Good  a%1 Heading 1G Heading 1 I}%O2 Heading 2G Heading 2 I}%?3 Heading 3G Heading 3 I}%234 Heading 49 Heading 4 I}% 5InputuInput ̙ ??v% 6 Linked CellK Linked Cell }% 7NeutralANeutral  e%"Normal 8Noteb Note   9OutputwOutput  ???%????????? ???:$Percent ;Title1Title I}% <TotalMTotal %OO= Warning Text? Warning Text %XTableStyleMedium9PivotStyleLight168dq:F3ffff̙̙3f3fff3f3f33333f33333\`MSupplemental Pay Forma|,*Employee Name:Funding Agency:OGC #:HalfBENEFITSNo Benefits (RGF)Plus Benefits (RGB)Benefits Include:Life HealthPAYMENTS BEGIN (mo/yr):ORMONTHLY DISTRIBUTION%General Ledger account to be charged:FundOrgAccountProgram01ApprovalDate:Office of Grants and ContractsFOR HUMAN RESOURCES PURPOSES: Date enteredEarn Code usedNo. of Payments RequestedTSECTION B: Complete SECTION B if no allowance has been made to cover FICA/Medicare. {FICA/MEDICARE: Complete ONE section below (A or B). (Calculations will be automatic when highlighted boxes are filled in.)  Retirement Only (RGR)Full Retirement# Payments Requested:Leave of Absence Sabbatical: College ID#:"Grant-Funded Supplemental Pay FormSummerSECTION A: Complete SECTION A if FICA/Medicare is listed in the grant budget as a separate cost in addition to the supplemental pay.. Supp. amount:Monthly amount:(Supp. amt after FICA/Medicare deduction:This form is to be used for all grant-related fellowships or supplemental pay for employees. Monies will be included on the employee's regular monthly paycheck, net of the appropriate taxes. Send completed form to LuAnne Sledge in the Grants and Contracts Office no later than May 15th. 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