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[]
["Request for a One-Time Deduction"]
["Instructions"]
["Use this form to request additional one time deductions for State of Arizona employees."]
["The One-Time Deduction form may be used to create an additional one-time deduction (in addition to a normal biweekly deduction), or to create a one-time deduction without any normal biweekly deduction. The form may be used to refund a retirement deduction that was taken in error in a previous pay period, and also adjust deductions between retirement systems. An example of a one-time deduction with a normal biweekly deduction is an additional retirement deduction to be taken because it was missed on a previous pay period. An example of a one-time deduction without a normal biweekly deduction is a one-time deduction for the recovery of a travel advance."]
["The General Accounting Office (GAO) Central Payroll Office will set up all approved one time deductions/adjustments requested by an agency. This does not include the various insurance deductions/adjustments that are created by the Benefits Section of the Department of Administration. Any Benefit related deductions need to be communicated to ADOA Benefits directly."]
["This form must be completed and submitted by 12:00 p.m. on compute Tuesday to be effective for the current pay period. Any requests received after 12:00 p.m. on Tuesday of payroll week may not be reviewed and/or processed until the subsequent payroll. Any forms incomplete or not submitted timely may not be processed."]
["Once completed, a GAO-3P authorized individual can email the request to Central.Payroll@azdoa.gov. "]
[]
["Key Terms"]
["Deduction Amount:","Enter the amount. This may be positive or negative. A positive amount indicates a deduction and negative amount indicates a refund."]
[]
["Deduction Code:","Select the deduction code from the list. If the code has a subsequent matching code, it will auto-populate in the second deduction code box. "]
[]
["Enter Date:","Enter the dates used for the deduction calculation. If the amount is for the entire pay period, enter the pay period end date (PPE)."]
[]
["Future Ded Date:","Enter the PPE date for the payroll the deduction should occur. This box is used when multiple retirement deductions need to be recovered and taking them all on one payroll will cause a hardship. For retirement deductions, use the PPE for the pay date from which the deduction should be taken."]
[]
["Wage Amount:","Enter the wages used to calculate the deduction amount."]

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[]
["Request for a One-Time Deduction"]
["Employee Information"]
["Agency"]
[]
["Employee Name",null,null,null,null,null,null,"EIN"]
[]
["One-Time Deduction Entry"]
[null,"Deduction Code and Description",null,null,null,null,"Deduction Amount","Wage Amount","Enter Date","Future Deduction Date"]
[1,"Ded Code","Select Deduction Code",null,null,null,{"$f":"G11*-1","v":0},0]
[null,"Match Code",{"$f":"VLOOKUP(C10, 'DEDUCTION CODE SELECTION'!A:B, 2, 0)","v":"Matching Code Will Auto-populate"},null,null,null,0,0]
[null,"Comment"]
[2,"Ded Code","Select Deduction Code",null,null,null,{"$f":"G14*-1","v":0},0]
[null,"Match Code",{"$f":"VLOOKUP(C13, 'DEDUCTION CODE SELECTION'!A:B, 2, 0)","v":"Matching Code Will Auto-populate"},null,null,null,0,0]
[null,"Comment"]
[3,"Ded Code","Select Deduction Code",null,null,null,{"$f":"G17*-1","v":0},0]
[null,"Match Code",{"$f":"VLOOKUP(C16, 'DEDUCTION CODE SELECTION'!A:B, 2, 0)","v":"Matching Code Will Auto-populate"},null,null,null,0,0]
[null,"Comment"]
[4,"Ded Code","Select Deduction Code",null,null,null,{"$f":"G20*-1","v":0},0]
[null,"Match Code",{"$f":"VLOOKUP(C19, 'DEDUCTION CODE SELECTION'!A:B, 2, 0)","v":"Matching Code Will Auto-populate"},null,null,null,0,0]
[null,"Comment"]
[5,"Ded Code","Select Deduction Code",null,null,null,{"$f":"G23*-1","v":0},0]
[null,"Match Code",{"$f":"VLOOKUP(C22, 'DEDUCTION CODE SELECTION'!A:B, 2, 0)","v":"Matching Code Will Auto-populate"},null,null,null,0,0]
[null,"Comment"]
[6,"Ded Code","Select Deduction Code",null,null,null,{"$f":"G26*-1","v":0},0]
[null,"Match Code",{"$f":"VLOOKUP(C25, 'DEDUCTION CODE SELECTION'!A:B, 2, 0)","v":"Matching Code Will Auto-populate"},null,null,null,0,0]
[null,"Comment"]
[7,"Ded Code","Select Deduction Code",null,null,null,{"$f":"G29*-1","v":0},0]
[null,"Match Code",{"$f":"VLOOKUP(C28, 'DEDUCTION CODE SELECTION'!A:B, 2, 0)","v":"Matching Code Will Auto-populate"},null,null,null,0,0]
[null,"Comment"]
[8,"Ded Code","Select Deduction Code",null,null,null,{"$f":"G32*-1","v":0},0]
[null,"Match Code",{"$f":"VLOOKUP(C31, 'DEDUCTION CODE SELECTION'!A:B, 2, 0)","v":"Matching Code Will Auto-populate"},null,null,null,0,0]
[null,"Comment"]
[9,"Ded Code","Select Deduction Code",null,null,null,{"$f":"G35*-1","v":0},0]
[null,"Match Code",{"$f":"VLOOKUP(C34, 'DEDUCTION CODE SELECTION'!A:B, 2, 0)","v":"Matching Code Will Auto-populate"},null,null,null,0,0]
[null,"Comment"]
[10,"Ded Code","Select Deduction Code",null,null,null,{"$f":"G38*-1","v":0},0]
[null,"Match Code",{"$f":"VLOOKUP(C37, 'DEDUCTION CODE SELECTION'!A:B, 2, 0)","v":"Matching Code Will Auto-populate"},null,null,null,0,0]
[null,"Comment"]
[]
["ASRS Employee Consent"]
["If the employee elects to have the missed ASRS contributions taken through payroll, they must sign the form allowing the deduction to occur through payroll. If the agency is not able to obtain a signature from the employee, or the employee refuses to sign the form, complete the Contributions Not Withheld process via the ASRS portal. Write \"Refused\" or \"Unable to obtain\" on the signature line. The form can still be submitted for ER contributions."]
["As of 1/1/2020 A.R.S. § 38-738 (E) requires written consent from the employee to deduct missed ASRS retirement contributions from their paycheck. Failure to sign will result in the agency submitting Contributions Not Withheld (CNW) which may result in additional fees and interest pursuant to ASRS guidelines."]
["I hereby request and authorize the State of Arizona to deduct missed ASRS employee retirement contributions as a pre-tax deduction from my paycheck as outlined above."]
[]
["Employee Signature",null,null,null,null,null,null,"Date"]
[]
[]
["Prepared by",null,null,null,null,null,"Reviewed by"]
["Name",null,null,null,null,null,"Name"]
["EIN",null,null,null,null,null,"EIN"]
["Phone",null,null,null,null,null,"Phone"]
["Date",null,null,null,null,null,"Date"]

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{"sheet":"DEDUCTION CODE SELECTION","index":3,"n_rows":163,"n_cols":2,"rows_kept":163,"cut":false,"hidden":true,"merged":[]}
["Select Deduction Code","Matching Code Will Auto-populate"]
["3201 - RENT ADOT - EE                "," - "]
["3203 - RENT DPS - EE                 "," - "]
["3205 - RENT G&F - EE                 "," - "]
["3207 - RENT ADOC - EE                "," - "]
["3213 - ADOC UTILITIES - EE           "," - "]
["3215 - ADOT UTILITIES - EE           "," - "]
["3217 - RENT ASDB - EE                "," - "]
["3221 - RENT PARK - EE                "," - "]
["3315 - RECOVERY-ADOA-EE              "," - "]
["3317 - RECOVERY-ADOC-EE              "," - "]
["3319 - RECOVERY-ADJC-EE              "," - "]
["3321 - RECOVERY-G&F-EE               "," - "]
["3323 - RECOVERY-DPS-EE               "," - "]
["3325 - RECOVERY-DOR-EE               "," - "]
["3327 - RECOVERY-AHCCCS-EE            "," - "]
["3329 - RECOVERY-DES-EE               "," - "]
["3331 - RECOVERY-ADOT-EE              "," - "]
["3333 - RECOVERY-ADHS-EE              "," - "]
["3413 - CORP CANCER INSURANCE PROGRAM "," - "]
["3513 - BUS CARD - REISSUE - EE       "," - "]
["3519 - DOC DOMICILE VEHICLE          "," - "]
["3521 - DOC VAN POOL                  "," - "]
["3707 - ASRS SYSTEM BUYBACK - EE      ","3708 - ASRS SYSTEM BUYBACK - ER      "]
["3709 - ASRS PLAN BUYBACK - PTX - EE  "," - "]
["3711 - ASRS PLAN BUYBACK - PTX - EE  "," - "]
["3713 - ASRS PLAN BUYBACK - PTX - EE  "," - "]
["3715 - ASRS PLAN BUYBACK - PTX - EE  "," - "]
["3717 - ASRS PLAN BUYBACK - PTX - EE  "," - "]
["3719 - ASRS PLAN BUYBACK - PTX - EE  "," - "]
["3721 - ASRS PLAN BUYBACK - PTX - EE  "," - "]
["3901 - MISCELLANEOUS RECOVERY        "," - "]
["3999 - OFF-SET DEDUCTION - EE        "," - "]
["4051 - CORP DOC EE AFTER TAX         ","4052 - CORP DOC ER AFTER TAX         "]
["4053 - ASRS PLAN EE AFTER TAX        ","4054 - ASRS PLAN ER AFTER TAX        "]
["4055 - CORP DJ EE AFTER TAX          ","4056 - CORP DJ ER AFTER TAX          "]
["4057 - PSRS EO&J EE AFTER TAX        ","4058 - PSRS EO&J ER AFTER TAX        "]
["4059 - PSRS DPS EE AFTER TAX         ","4060 - PSRS DPS ER AFTER TAX         "]
["4061 - PSRS G&F EE AFTER TAX         ","4062 - PSRS G&F ER AFTER TAX         "]
["4063 - PSRS AGI EE AFTER TAX         ","4064 - PSRS AGI ER AFTER TAX         "]
["4065 - PSRS FF EE AFTER TAX          ","4066 - PSRS FF ER AFTER TAX          "]
["4067 - PSRS CAP POL EE AFTER TAX     ","4068 - PSRS CAP POL ER AFTER TAX     "]
["4069 - PSRS LIQ CON EE AFTER TAX     ","4070 - PSRS LIQ CON ER AFTER TAX     "]
["4071 - ASRS SYS EE AFTER TAX         ","4072 - ASRS SYS ER AFTER TAX         "]
["4073 - PSRS PRKS EE AFTER TAX        ","4074 - PSRS PRKS ER AFTER TAX        "]
["7320 - BASIC LIFE - ER               "," - "]
["7508 - LTD ASRS - ER                 ","7509 - LTD ASRS - EE                 "]
["7510 - RETIRE-REFUND-LTD-ER          ","7511 - RETIRE-REFUND-LTD-EE          "]
["7520 - HARTFORD LONG TERM DISABILITY "," - "]
["7521 - DISABILITY PSRS 007-EE        ","7522 - DISABILITY PSRS 007-ER        "]
["7523 - DISABILITY PSRS 035-EE        ","7524 - DISABILITY PSRS 035-ER        "]
["7525 - DISABILITY PSRS 151-EE        ","7526 - DISABILITY PSRS 151-ER        "]
["7527 - DISABILITY PSRS 119-EE        ","7528 - DISABILITY PSRS 119-ER        "]
["7529 - DISABILITY PSRS 164-EE        ","7530 - DISABILITY PSRS 164-ER        "]
["7531 - DISABILITY PSRS 204-EE        ","7532 - DISABILITY PSRS 204-ER        "]
["7533 - DISABILITY CORP 500-EE        ","7534 - DISABILITY CORP 500-ER        "]
["7535 - DISABILITY CORP 501-EE        ","7536 - DISABILITY CORP 501-ER        "]
["7537 - DISABILTY CORP 563-EE         ","7538 - DISABILTY CORP 563-ER         "]
["7539 - DISABILTY CORP 564-EE         ","7540 - DISABILTY CORP 564-ER         "]
["7542 - METLIFE LONG TERM DISABILITY"," - "]
["7610 - HEALTH SUBSIDY CORP 500-ER","7611 - HEALTH SUBSIDY CORP 500-EE"]
["7619 - HEALTH SUBSIDY PSRS 007-EE","7618 - HEALTH SUBSIDY PSRS 007-ER"]
["7813 - RETIRE - EODCRS - EE          ","7814 - RETIRE - EODCRS - ER          "]
["7815 - DEFERRED COMPENSATION % - EE  "," - "]
["7816 - SUPP DC PLAN MATCH 7803 $ - ER"," - "]
["7901 - RETIRE - CORP DOC - EE        ","7902 - RETIRE - CORP DOC - ER        "]
["7903 - RETIRE - ASRS PLAN - EE       ","7904 - RETIRE - ASRS PLAN - ER       "]
["7905 - RETIRE - CORP DJC - EE        ","7906 - RETIRE - CORP DJC - ER        "]
["7907 - RETIRE - EO&J - EE            ","7908 - RETIRE - EO&J - ER            "]
["7909 - RETIRE - PSRS DPS - EE        ","7910 - RETIRE - PSRS DPS - ER        "]
["7911 - RETIRE - PSRS G&F - EE        ","7912 - RETIRE - PSRS G&F - ER        "]
["7913 - RETIRE - PSRS AGI - EE        ","7914 - RETIRE - PSRS AGI - ER        "]
["7915 - RETIRE - PSRS FF - EE         ","7916 - RETIRE - PSRS FF - ER         "]
["7917 - RETIRE - ABOR/ORP - EE        ","7918 - RETIRE - ABOR/ORP - ER        "]
["7919 - RETIRE - ASRS - EO&J - EE     ","7920 - RETIRE - ASRS - EO&J - ER     "]
["7921 - RETIRE - PSRS CAP POL - EE    ","7922 - RETIRE - PSRS CAP POL - ER    "]
["7923 - RETIRE - PSRS LIQ CON - EE    ","7924 - RETIRE - PSRS LIQ CON - ER    "]
["7931 - RETIRE - PSRS - PRKS - EE     ","7932 - RETIRE - PSRS PRKS - ER       "]
["7933 - RETIRE - CORP DPS DISP - EE   ","7934 - RETIRE - CORP DPS DISP - ER   "]
["7936 - ALT CONTRIB RATE - DPS (007)  "," - "]
["7938 - ALT CONTRIB RATE - DOC (500)  "," - "]
["7940 - ALT CONTRIB RATE - EO&J (415) "," - "]
["7942 - ALT CONTRIB RATE - DJ (501)   "," - "]
["7944 - ALT CONTRIB RATE - DISP (563) "," - "]
["7946 - ALT CONTRIB RATE - G&F (035)  "," - "]
["7948 - ALT CONTRIB RATE - AGI (151)  "," - "]
["7950 - ALT CONTRIB RATE - FIRE (119) "," - "]
["7952 - ALT CONTRIB RATE - LIQ (164)  "," - "]
["7954 - ALT CONTRIB RATE - PARK (204) "," - "]
["7955 - RETIREMENT DROP PSRS 035-EE   "," - "]
["7956 - ALT CONTRIBUTION RATE - ASRS  "," - "]
["7957 - RETIRE - DEF RET OPT DROP - EE"," - "]
["7958 - RETIREMENT ACR CORP 564-ER    "," - "]
["7959 - RETIRE-REFUND-ASRS-EE         ","7960 - RETIRE-REFUND-ASRS-ER         "]
["7961 - RETIRE - CORP DPS DETEN - EE  ","7962 - RETIRE - CORP DPS DETEN - ER  "]
["7964 - RETIRE - SUPP BENE - CORP     "," - "]
["7966 - RETIRE - SUPP BENE - DJC      "," - "]
["7968 - RETIRE - SUPP BENE - DISP     "," - "]
["7970 - RETIRE - SUPP BENE - DPS      "," - "]
["7972 - RETIRE - SUPP BENE - G&F      "," - "]
["7974 - RETIRE - SUPP BENE - AGI      "," - "]
["7976 - RETIRE - SUPP BENE - FIRE     "," - "]
["7978 - RETIRE - SUPP BENE - LIQ      "," - "]
["7980 - RETIRE - SUPP BENE - PARK     "," - "]
["7982 - RETIRE-SUP BENE-CORP DPS DETN "," - "]
["7984 - RETIRE - ASRS LEGACY          "," - "]
["7986 - RETIRE - EODCRS LEGACY - ER   "," - "]
["7987 - EODCRS DISABILITY - EE        ","7988 - EODCRS DISABILITY - ER        "]
["R001 - RETIREMENT EORP 415 T2-EE     ","R002 - RETIREMENT EORP 415 T2-ER     "]
["R003 - RETIREMENT PSRS PS 007 T2-EE     ","R004 - RETIREMENT PSRS PS 007 T2-ER     "]
["R005 - RETIREMENT PSRS GF 035 T2-EE     ","R006 - RETIREMENT PSRS GF 035 T2-ER     "]
["R007 - RETIREMENT PSRS AG 151 T2-EE     ","R008 - RETIREMENT PSRS AG 151 T2-ER     "]
["R009 - RETIREMENT PSRS FF 119 T2-EE     ","R010 - RETIREMENT PSRS FF 119 T2-ER     "]
["R011 - RETIREMENT PSRS LL 164 T2-EE     ","R012 - RETIREMENT PSRS LL 164 T2-ER     "]
["R013 - RETIREMENT PSRS PR 204 T2-EE     ","R014 - RETIREMENT PSRS PR 204 T2-ER     "]
["R015 - RETIREMENT PSRS PS 007 T3 DB-EE  ","R016 - RETIREMENT PSRS PS 007 T3 DB-ER  "]
["R017 - RETIREMENT PSRS GF 035 T3 DB-EE  ","R018 - RETIREMENT PSRS GF 035 T3 DB-ER  "]
["R019 - RETIREMENT PSRS AG 151 T3 DB-EE  ","R020 - RETIREMENT PSRS AG 151 T3 DB-ER  "]
["R021 - RETIREMENT PSRS FF 119 T3 DB-EE  ","R022 - RETIREMENT PSRS FF 119 T3 DB-ER  "]
["R023 - RETIREMENT PSRS LL 164 T3 DB-EE  ","R024 - RETIREMENT PSRS LL 164 T3 DB-ER  "]
["R025 - RETIREMENT PSRS PR 204 T3 DB-EE  ","R026 - RETIREMENT PSRS PR 204 T3 DB-ER  "]
["R027 - RETIREMENT PSRS PS 007 T3 DC-EE  ","R028 - RETIREMENT PSRS PS 007 T3 DC-ER  "]
["R029 - RETIREMENT PSRS GF 035 T3 DC-EE  ","R030 - RETIREMENT PSRS GF 035 T3 DC-ER  "]
["R031 - RETIREMENT PSRS AG 151 T3 DC-EE  ","R032 - RETIREMENT PSRS AG 151 T3 DC-ER  "]
["R033 - RETIREMENT PSRS FF 119 T3 DC-EE  ","R034 - RETIREMENT PSRS FF 119 T3 DC-ER  "]
["R035 - RETIREMENT PSRS LL 164 T3 DC-EE  ","R036 - RETIREMENT PSRS LL 164 T3 DC-ER  "]
["R037 - RETIREMENT PSRS PR 204 T3 DC-EE  ","R038 - RETIREMENT PSRS PR 204 T3 DC-ER  "]
["R039 - RETIREMENT CORP DC 500 T3 DC-EE  ","R040 - RETIREMENT CORP DC 500 T3 DC-ER  "]
["R041 - RETIREMENT CORP DJ 501 T3 DC-EE  ","R042 - RETIREMENT CORP DJ 501 T3 DC-ER  "]
["R043 - RETIREMENT CORP DISP 563 T3 DC-EE  ","R044 - RETIREMENT CORP DISP 563 T3 DC-ER  "]
["R045 - RETIREMENT CORP DET OFC 564 T3 DC-EE  ","R046 - RETIREMENT CORP DET OFC 564 T3 DC-ER  "]
["R100 - RETIREMENT LEGACY PSRS 007-ER "," - "]
["R102 - RETIREMENT LEGACY PSRS 035-ER "," - "]
["R104 - RETIREMENT LEGACY PSRS 151-ER "," - "]
["R106 - RETIREMENT LEGACY PSRS 119-ER "," - "]
["R108 - RETIREMENT LEGACY PSRS 164-ER "," - "]
["R110 - RETIREMENT LEGACY PSRS 204-ER "," - "]
["R112 - RETIREMENT LEGACY CORP 500-ER "," - "]
["R114 - RETIREMENT LEGACY CORP 501-ER "," - "]
["R116 - RETIREMENT LEGACY CORP 563-ER "," - "]
["R118 - RETIREMENT LEGACY CORP 564-ER "," - "]
["R200 - RETIREMENT SUP PSRS 007 T2-ER "," - "]
["R202 - RETIREMENT SUP PSRS 035 T2-ER "," - "]
["R204 - RETIREMENT SUP PSRS 151 T2-ER "," - "]
["R206 - RETIREMENT SUP PSRS 119 T2-ER "," - "]
["R208 - RETIREMENT SUP PSRS 164 T2-ER "," - "]
["R210 - RETIREMENT SUP PSRS 204 T2-ER "," - "]
["R212 - RETIREMNT SUP PSRS 007 T3DB-ER"," - "]
["R214 - RETIREMNT SUP PSRS 035 T3DB-ER"," - "]
["R216 - RETIREMNT SUP PSRS 151 T3DB-ER"," - "]
["R218 - RETIREMNT SUP PSRS 119 T3DB-ER"," - "]
["R220 - RETIREMNT SUP PSRS 164 T3DB-ER"," - "]
["R222 - RETIREMNT SUP PSRS 204 T3DB-ER"," - "]
["R224 - RETIREMNT SUP PSRS 007 T3DC-ER"," - "]
["R226 - RETIREMNT SUP PSRS 035 T3DC-ER"," - "]
["R228 - RETIREMNT SUP PSRS 151 T3DC-ER"," - "]
["R230 - RETIREMNT SUP PSRS 119 T3DC-ER"," - "]
["R232 - RETIREMNT SUP PSRS 164 T3DC-ER"," - "]
["R234 - RETIREMNT SUP PSRS 204 T3DC-ER"," - "]
["R236 - RETIREMNT SUP CORP 500 T3DC-ER"," - "]
["R238 - RETIREMNT SUP CORP 501 T3DC-ER"," - "]
["R240 - RETIREMNT SUP CORP 563 T3DC-ER"," - "]
["R242 - RETIREMNT SUP CORP 564 T3DC-ER"," - "]