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Employee Payroll Change Form Template

Effortlessly Update Employee Pay Rates with This Template

Adjusting employee pay rates can be complex, but with the right form, it becomes a breeze. This Payroll Change Form Template is designed for HR professionals and managers, ensuring clear and accurate communication of salary adjustments. With this template, you can streamline payroll updates, maintain compliance with documentation requirements, and facilitate prompt processing of changes, all while keeping records organized. Plus, it's accessible with WCAG-aligned labels to ensure everyone can use it easily. Explore this live template to simplify your payroll updates.

Use this Template (FREE) Live Preview
Employee full name
Employee ID
Work email
Phone number
Department
Job title
Work location (state/province and country)
Type(s) of payroll change requested
Direct deposit (bank account)
Tax withholding
Pay rate
Pay frequency
Deductions
Personal information affecting payroll (e.g., legal name)
One-time pay adjustment
Stop payment/reissue
Other
Please Specify:
Effective date of change
Additional notes (if any)
Reason for change
Employee request
Promotion/role change
Life event (marriage, divorce, dependent)
Bank account change/closure
Compliance requirement
Correction to previous payroll
Other/Not sure
New pay type
Hourly
Salary
Contract/fixed fee
No change
New base rate (e.g., hourly rate or salary)
Pay frequency
Weekly
Biweekly
Semimonthly
Monthly
Other/No change
Standard hours per week
One-time pay adjustment requested?
Yes
No
One-time pay adjustment amount and description
Tax withholding jurisdiction (country/state)
Filing status for withholding
Single
Married
Married but withhold at higher single rate
Head of household
Other/Not applicable
Additional amount to withhold per pay period (if any)
Exempt from withholding?
Yes
No
Direct deposit request type
New
Update
Cancel
No change
Bank name
Routing/SWIFT or sort code
Account number/IBAN
Account type
Checking
Savings
Other
Please Specify:
Deposit allocation
Entire net pay
Percentage
Fixed amount
Allocation amount or percentage (if applicable)
Deduction change type
Add new
Change amount
Cancel
No change
Deduction type
Retirement (e.g., 401k/pension)
Health/benefits premium
Wage garnishment
Charitable/voluntary
Other
Please Specify:
Deduction amount per pay period
Deduction tax treatment
Pre-tax
After-tax
Not sure
Employee signature (type full name)
Date signed by employee
Manager/supervisor approval name
Manager/supervisor email
HR/Payroll approval name
HR/Payroll email
Approval date
I confirm the information provided is accurate and authorize payroll to make the changes listed.
Yes
No
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Paper art illustration depicting an employee payroll change form template for FormCreatorAI article

When to use this form

Use this template when you need to update an employee's compensation without creating a new record. Common cases include a merit increase, market adjustment, shift differential, moving from hourly to salary, a location transfer with a new pay band, or correcting an underpayment with retro pay. You, HR, and payroll get one clear request that routes for approval and leaves a clean audit trail, so paychecks and taxes are right the first time. For non-pay updates like title, manager, or department, use the Employee change form. If the person is brand new to your organization, start with the New hire request form instead.

Must Ask Employee Payroll Change Questions

  1. What is the effective date, and does this include any retro pay period?

    This locks the change to the correct payroll cycle and prevents missed or duplicate payments. If retroactive, payroll can calculate back pay and the tax impact accurately.

  2. What are the current and new pay details (rate, basis, frequency, and standard hours)?

    Side-by-side numbers reduce errors when updating the system. Basis and hours ensure overtime, benefits, and accruals stay accurate.

  3. Why is the pay changing, and what documentation supports it?

    Clear rationale speeds approvals and supports audits. Use the Wage increase form for raises and the Promotion justification form for role changes.

  4. Which cost center, project, or grant will fund this change?

    Finance needs the correct account to post the difference. It also confirms budget availability and prevents month-end corrections.

  5. Will the work location or FLSA status change?

    Location drives tax withholding and local wage rules. FLSA status affects overtime and must stay consistent with the new pay.

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