Once this information is entered, complete ONLY the administrative data that is being changed. Effective Date Enter the date on which the change in administrative data is effective. Enter the four-position code to identify the reason why the change in administrative data is being made to the employee's record. Codes are listed on the reverse side of the change form . Ensure that it is the same number entered on the Employee's W-4 Form.
Last Name Enter the employee's changed last name.
If the employee has multiple Research Foundation appointments and more than one title, enter the employees changed primary title code. Enter the changed street address, apartment number, P.O. Box, Rural delivery Route, or other address information, including any changes to City, State, County, and Zip Code. Mailing Address Enter the person's mailing address if it has changed. Visa Type Check the appropriate box if the visa typed has changed. If the visa type is not listed, check the box marked OTH and enter the visa type in the space provided.