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Payroll Change Notice Form Template

Streamline Payroll Updates with Our Easy-to-Use Template

Keeping employees informed about payroll changes can be a challenge. This Payroll Change Notice Form Template helps HR teams efficiently communicate updates to pay information, ensuring clarity and compliance. With this template, you can quickly notify employees of pay adjustments, changes in pay dates, and other crucial payroll modifications, all while maintaining accurate records. Plus, it's designed to be user-friendly and WCAG-aligned for accessibility, making it easier for everyone involved. Explore how this template can simplify your payroll communications today.

Employee full name
Employee ID or number
Department
Job title
Contact email
Contact phone
Change effective date
Type(s) of payroll change requested
Please Specify:
Reason for change
Please Specify:
Current pay type
Hourly
Salary
Piece rate
Commission only
Stipend
Not applicable
Other
Please Specify:
Current pay rate (enter amount and unit, e.g., $25/hour or $65,000/year)
New pay type
Hourly
Salary
Piece rate
Commission only
Stipend
Not applicable
Other
Please Specify:
New pay rate (enter amount and unit, e.g., $27/hour or $70,000/year)
Pay frequency
Weekly
Biweekly (every 2 weeks)
Semimonthly (twice per month)
Monthly
Not applicable
Other
Please Specify:
Direct deposit action
Add new account
Update existing account
Remove account
Not applicable
Bank name
Account type
Checking
Savings
Not applicable
Other
Please Specify:
Routing number
Account number
Allocation amount or percentage (if applicable)
Deposit allocation
100% to this account
Specific amount per paycheck
Specific percentage per paycheck
Remainder/balance to this account
Not applicable
Federal filing status
Single
Married filing jointly
Married filing separately
Head of household
Not applicable
Additional federal withholding amount per paycheck (if any)
State withholding change
Yes
No
State of withholding (if applicable)
Exempt from withholding
Yes
No
What personal information is changing
Legal name
Home address
Mailing address
Phone
Email
Marital status
Emergency contact
Other
Please Specify:
New legal name
New home address
New mailing address
New phone
New email
New marital status
Single
Married
Divorced
Widowed
Domestic partnership/civil union
Prefer not to say
Not applicable
Describe the deduction/benefit change
Deduction or benefit change type(s)
Health insurance
Retirement plan
HSA/FSA
Garnishment
Union dues
Parking/Transit
Not applicable
Other
Please Specify:
Notes or special instructions
Employee signature (type full name)
Signature date
I confirm the information provided is accurate and authorize payroll to process these changes
Yes
No
Received date
Processed by
Effective payroll period start date
Admin notes
{"name":"Employee full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Employee full name, Employee ID or number, Department","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration depicting a payroll change notice form for an article on FormCreatorAI

When to use this form

Use this form any time pay details need to change for an employee. Typical cases include a promotion or market adjustment, which you may pair with the Wage increase form; a move from hourly to salaried; a shift in pay frequency or pay date; or a cost center or job status change. You also can use it to correct a start rate or add a one-time stipend. You and your payroll team benefit from a clear audit trail, accurate calculations, and fewer last-minute fixes. If you are proposing a base pay change, start approvals with the Request for salary change form and then submit the final numbers here. When pay frequency changes, remind the employee to review withholding on the W4 Form to avoid surprises.

Must Ask Payroll Change Notice Questions

  1. What type of payroll change are you requesting?

    Knowing whether it is a rate change, pay frequency shift, pay date update, job status change, or cost center move routes the request to the right workflow. It also triggers the correct fields and validations, which reduces errors and rework.

  2. What is the effective date and the pay period it applies to?

    Payroll needs this to process the update before cutoff and avoid retro pay. It ensures the change lands on the intended paycheck.

  3. What are the current pay details and the new pay details (rate, frequency, hours/FTE, and exemption status)?

    Capturing both sides side-by-side prevents miscalculations and keeps you compliant with wage and hour rules. It gives payroll clear instructions for system updates.

  4. What is the reason for the change and who approved it?

    Stating the business reason and the approver creates an audit trail for finance and HR. It also confirms that only authorized changes move forward.

  5. What supporting documents are attached?

    Attaching the approval memo or signed offer helps payroll verify the source of the change. If the change comes from a new offer, link it to the Offer letter submission form for quick cross-checking.

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