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Warning Text %XTableStyleMedium2PivotStyleLight16`F Instructions HForm8 I;Unit No.*REQUEST FOR ADDITIONAL PAYMENT TO EMPLOYEE!CERTIFICATION BY BORROWING AGENCYName of AgencyName of Employee#Nature & Location of Work Performed Dates WorkedRate & Time if AppropriatedAgency Code and Subhead(Signature of Contracting Agency Official (Fill in as Applicable)' Analysis of Payrment to Parent AgencySECTION=* Borrowing agency is assuming liability for accuracy and %statutory compliance for these items.*Travel& & & & & & & & & ..& & & & & & & ..*Total Payment Due Parent Agency& & ...& .....%Salary for Service& & ....& .& & .& & & ..& & .Gross due Employee& & ....& & & & & ..Indirect Expense& & & & & & & & & & & & & Direct Cost& & & & ...& & & & & & & & & & . Matching Retirement& ..& & & & & .& & & &  CERTIFICATION BY PARENT AGENCYClassification, Rank or TitlePosition NumberSocial Security Number Agency Code Subhead CodeRetirement CodeDI certify that the above amount has been received from the Borrowing?Agency and deposited in our account. Pay employee gross salary amount of $@(This is for Payroll purposes and should not include travel and subsistence.)Budget Officer (Parent Agency) in addition to regular salary.W. FOR WORK PERFORMED FOR ANOTHER STATE AGENCYBWe hereby certify that the actual work and the related travel time;were both performed on the employee's own time, outside of >regular scheduled working hours, and that the employee has notAused "company time" to prepare for his services to the borrowing agency.Department HeadImmediate SupervisorEmployee*Subsistence& & & & & & & & & & & & & & & 'Matching Social Security& & & .....& ...& & & OSCPXA 03d INSTRUCTIONS: The borrowing agency is responsible for originating this form in triplicate, using a separate set for each employee. Unless special arrangements have been made for invoicing of the borrowing agency by the parent agency, the Borrowing Agency will forward all copies of OSCPXA 03 to the parent agency, accompanied by their check for the employee's services as evidenced by their completion of Section One below. Upon completing Section Two, the Parent Agency budget officer will send the original to his payroll clerk as authorization to pay the borrowed employee his additional salary. The second copy will be filed by Parent Agency and the third copy will be returned to the Borrowing Agency. It is the responsibility of the parent agency to avoid over-collection of matching social security tax and/or under-collection of matching retirement.  (   UNDER CONSTRUCTIONCHECK "WHAT'S NEW" FOR UPDATES"Dual Employment Certification FormB. s/0|a1283Qk59= cc@ VPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V@  7ggD T8 ;N[g  dMbP?_*+%&'()M\\NC\OSCSAD02.Controller.OSC.St?dXXLetter.HP LaserJet 8000 Series PCL 5e2xuUK0?`v_ixTuÄ7IKJEsʉ_MaykeC` k*i#8eFU]/D3^`@÷Ŏ[w1k {hb2=?(+=+M|@'93E|,{9 Ѫ:*W:_0 ҀFtl 1;=EeT(G `fwupM>#3@p1AB}QP8Uճs BhALphy3o]Ӷцcz2p,s@bCA8XlI^n>_WmeʿYa9s˿G+5n]! qXuVgxs:]iZn>ق"dXX?&U} mU} $} } I} } $} } } } I} } m} m } $} } } } m} } } } } } } $;J @i@&@@ @  @  @ @  @@ @@ @@ @@ @J@ @@ @@ @@@@@ c6 cd Z: ?> ? ?+ ]72]]]]]]]]]]]]]]]]]^^^^^>VCCCCCCCCCCCCCJCCCCCCCCCCCCD NA Q AAAAAAAAAAAKA E AAAAAAAAAAF N ( AAAAAAAAAAAAAKAAA E  AAAAAAAAF N " A\\\\\\\\\\\AK G AAAAAAAAA\\F OB B8 BBBBBBBBBBBLBBBBBBBBBBBBH N" A\\\\\\\\\\\AK G AAAAAAAAA\\F OB B8 BBBBBBBBBBBLBBBBBBBBBBBBH N"A\\\\\\\\\\\AK G4AAAAAAAAA\\F OB B8BBBBBBBBBBBLBBBBBBBBBBBBH N$A\\\\\\\\\\\AKA GAAAAAAAA\\F OB B8BBBBBBBBBBBLBBBBBBBBBBBBH N"A\\\\\\\\\\\AK GAAAAAAAAA\\F OB B8BBBBBBBBBBBLBBBBBBBBBBBBH N"A\\\\\\\\\\\AK R5AAAAAAAAA\\F OB B8BBBBBBBBBBBLBBBBBBBBBBBBH OB  BL GBBBBBBBBBffH OB$ BLBBBBBBBBBBBBH N"A\\\\\\\\\\\AK GAAAAAAAAA\\F OB B 8BBBBBBBBBBBLBBBBBBBBBBBBH NA  AK GAAAAAAAAA\\F NA$ AKGAAAAAAAAAPPF e A$ AKAAAAAAAAAAAAF$eAAAAAAAAAAAAAK GAAAAAAAAAAAF&NAAAAAAAAAAAAAKA a_________AF>W>>>>>>>>>>>>>M>>>>>>>>>>>>ID lBDBnddXdXdXdXdXdXL6dXV6@XX @!@ "@#$@%w@ &@'w@ (@)w@ *@+w@ ,@-w@ .@/@ 0@1@2@3@ 4@5@ 6;@7@ 8@9@ :! >>>>>>>>>>>"VCCCCCCCCASSSSSSSSSCCCCCCCCD#NAAAAAAAA # Q*# SSSSSSSSSAAAAAAAAF>$NAAAAAAAASSSSSSSSSSAAAAAAAAF %N <%A\\\\\\\\\\\AKAAAAAAAAAAAAF &OB &B8&BBBBBBBBBBBLBBBBBBBBBBBBH 'N "'A\\\\\\\\\\\AK 'E,'AAAAAAAAAAAF (OB (B8(BBBBBBBBBBBLBBBBBBBBBBBBH )N")A\\\\\\\\\\\AK )E-)AAAAAAAAAAAF *OB *B8*BBBBBBBBBBBLBBBBBBBBBBBBH +N"+A\\\AA\\\\\\AK +E.+AAAAAAAAAAAF ,OB ,B,BBBB ,B.,BBBBBBLBBBBBBBBBBBBH -N"-A\\\A\\\\\PTAK -E/-AAAAAAAAAAAF .OB .B .BBB .B!.BBBB . 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