CURRENT ACTION CODE

Enter ‘11’, corresponding to ‘Data Update.’

EFFECTIVE DATE OF UPDATE

Enter date on which the change is to be effective.

EMPLOYEE ID NO.

If the University assigned the academic employee a temporary identification number, but the academic employee has since obtained an official Social Security Number, write the number in the space provided. Send the PAF along with a photocopy of the SSN card directly to the Payroll Department.

NAME

Enter the academic employee’s full first and last name, in case of a change or error.

MAILING ADDRESS

Enter a complete U.S. or foreign address. Note that this is the mailing address for University correspondence, such as the W-2 form.

HOME PHONE

Enter a home phone number, if available.

FOREIGN ADDRESS

UNIV ADDRESS

Enter either the building name, room number, and box or a mail-code.

WORK PHONE

Enter a phone number at which the academic employee may be reached.

UC STUDENT

Indicate whether or not the employee is currently a U of C student.

UC STUDENT I.D. NO.

Enter the 6-digit University of Chicago student ID number. This number is necessary for verification of student registration status.

CHECK DELIVERY CODE

Indicate where paychecks/pay advices are to be delivered, using a department number (including the two digit executive level prefix).

EMERGENCY CONTACT

Enter the name, relationship, and phone number of a person who may be contacted in the case of an emergency involving the employee.

LICENSURE/

CERTIFICATION

Enter the nine digit medical license number, and expiration date.

SEX

Enter correct value, ‘M’ for male and ‘F’ for female.

BIRTHDATE

Enter the academic employee’s correct date of birth in the format MM/DD/YY.

RACE

Check the appropriate line; required by equal opportunity laws.

MILITARY STATUS

MARITAL STATUS

Enter the correct value, ‘M’ for married, ‘S’ for single.

EDUCATION LEVEL