Title 42 – Clinical Research Support

Request for Individual Salary Assignment or Increase

Action Type and Employee Information

Employee Name: Employee Name	Dept/Section: Dept/Sect	Unit/Manager: Unit/Mgr Name
Proposed Position: Position Title	Position Series: Series
Proposed Pay Cluster: Cluster	Proposed Pay Band: Band	Proposed Annual Salary: $
Pay Basis: Full Time or Part-Time. If Part-time, # hours per pay period: hours
Requested Start Date: Start Date	Length of Probationary Period: # years years (for new employees)

Justification of Proposed Pay Rate
For New Employee:

(Initial Assignment To Pay Band and Rate)

Describe the following in “Justification”, below or in an attachment:

Qualifications and competencies;

For Nursing, indicate competency level: level

Current salary and benefit package;

Criticality of the program assignment;

Supervisory/managerial responsibility; and/or

Market rate for the position.	For Current Employee:

(Increase within the Current Band or Movement to a New Band)

Pay Increase within Current Pay Band or

Assignment to Higher Pay Band and Rate, based on:

Competitive Recruitment Action

Accretion of Duties or Other Non-Competitive Action

Proposal represents an increase of $ (annual amount) from the current salary of $ .

Describe the employee’s growth in competencies and/or increase in responsibilities in “Justification”, below or in an attachment
Justification (use additional sheet as necessary)

For new employees: Describe competency assessment and/or job responsibilities relevant to pay setting along with any other factors pertinent to the initial pay setting (see above). Include one or more current pay slip(s) to fully document current pay rate. For guidance on increases above 5%, see http://ohrm.cc.nih.gov/pay/T42GeneralCompensation.htm

For current employees: Describe competency growth or increase in responsibilities.

Certification:

I certify that this action supports CC goals of fair and equitable compensation of employees.	I certify that funds are available within the salary budget for this action.
__________________________________________ _________________

Department Head’s Signature Date

Approvals: (Approval levels are based on the employee’s band assignment.)

Band I – Entry/Full Performance

__________________________________________ _________________

Department Head’s Signature Date
Band II – Expert/Specialist

___________________________________________ _________________

Deputy/Associate Director’s Signature Date
Band III – Sr. Spec/Exec/Mgr

___________________________________________ _________________

Director’s Signature Date

Additional Information to be submitted to the Office of Human Resources

Statement of Duties (for new assignment)

Pay Slip(s) (for new employee)

CCT42-2 06-25-04

Title 42 – Clinical Research Service

SReed

2001-10-03

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OHRM