UW-MADISON

EMPLOYMENT OVERLOAD REQUEST FORM

Overloads are short-term, temporary work assignments to meet special needs only. Before UW-Madison faculty, academic staff or limited appointees or classified permanent or project employees assume additional responsibilities for additional compensation from the same department, other UW-Madison units, other UW System institutions, or other State agencies, they should obtain required prior approvals noted on this form (below or reverse side). (Overload requests for employees from other UW System institutions must be processed as inter-institutional agreements using an IIA form [in accordance with FPPP #18], with a notation that "payment is an overload." Do not use the Employment Overload Request Form.) If the additional employment and the employee's continuing UW-Madison employment does not exceed 100 percent time during the specific period the additional work is being performed, overload approval is not necessary. Recurring special assignments for unclassified staff should be handled through some method other than overload payments. See Chapter 11.01 of the UW-Madison Classified or Unclassified Personnel Policies & Procedures for additional information.

EMPLOYEE INFORMATION:

EMPLOYEE’S NAME: SSN:

CURRENT
EMPLOYING
DEPARTMENTS:
 UDDS: %Time: Appt ID#:
UDDS: %Time: Appt ID#:
UDDS: %Time: Appt ID#:

CURRENT SALARY AND BASIS:      CURRENT TITLE:

PROPOSED OVERLOAD:

DEPARTMENT/INSTITUTION/AGENCY: UDDS:
UDDS:
PROPOSED POSITION TITLE: (If the overload is for job duties outside the employee's current appointment(s), a new appointment must be established under existing open recruitment policies with an appropriate position title.)

DESCRIPTION OF DUTIES:

DURATION OF OVERLOAD ASSIGNMENT: (Start Date) (End Date)

TOTAL EXPECTED PAYMENT FOR OVERLOAD ASSIGNMENT: $ FUND/ACCT:

Please if outreach education or independent study assignment.

[NOTE: Federal cost principles do not permit charging more than 100% of an individuals base salary to federal awards and/or non-federal funds which are used as cost sharing on a federal award. The only exception to this restriction is where the arrangement has been specifically provided for in the award or approved in writing by the sponsoring agency.]

PREVIOUS OVERLOAD PAYMENTS:

LIST ALL OVERLOADS PAID BEGINNING JANUARY 1 OF CURRENT YEAR: (Wis. Stats. 16.417(2) limits short-term/temporary overload assignments to $12,000 paid in a calendar year from each state agency or UW System institution. Failure to list all overloads may result in an overpayment violating state law and may require the employee to forfeit earnings.)

AGENCY: COMPENSATION:
AGENCY: COMPENSATION:

OVERLOAD APPROVAL:
DEPARTMENT CREATING OVERLOAD: ___________________________________________ _________________
(Department Chair/Supervisor) (Date)
___________________________________________ _________________
(Dean/Director) (Date)
___________________________________________ _________________
(Vice Chancellor--if another UW System Institution) (Date)
CURRENT UW-MADISON EMPLOYING DEPARTMENT: ___________________________________________ _________________
(Department Chair/Supervisor) (Date)
___________________________________________ _________________
(Dean/Director) (Date)
UW-MADISON FINAL APPROVAL: ___________________________________________ _________________
(Vice Chancellor or Designee) (Date)

RETURN COMPLETED FORM TO 166 BASCOM HALL
BEFORE OVERLOAD EFFECTIVE DATE


9/06