Priority Number

Small Payroll Status Change Form - 3-Part


Clearly communicate and record compensation changes

Clearly document pay changes with the Small Payroll Status Change Form - 3-Part. Having hard copies of any changes eliminates any uncertainty and offers solid documentation in the event a legal dispute.

Updated to include a new payroll/status change reason "FLSA Reclassification".


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  • Provides written record of how pay is changing and why
  • Provides two extra copies for employee and for recordkeeping
  • Includes ComplyRight™ tips for optimal, compliant use

Product Specifications:

  • Size: 5.5” x 8.5”
  • Sold in packs of 50