Fillable Adjustment Report - NPERS6200 ADJUSTMENT REPORT (Nebraska)

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Adjustment Report - NPERS6200 ADJUSTMENT REPORT (Nebraska)

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REPORTING
PERIOD
EMPLOYEE NAME
SSN
HOURS
REPORTED TO
NPERS
CORRECT
AMOUNT
OF HOURS
HOURS
ADJUSTMENT
AMOUNT (+/-)
COMPENSATION
REPORTED TO
NPERS
COMPENSATION
ADJUSTMENT
AMOUNT (+/-)
EMPLOYEE
CONTRIBUTIONS
(+/-)
SCHOOL ADJUSTMENT REPORT
Submit through fax and mail ONLY. “To make an Employee Contribution adjustment older than 12 months, please contact NPERS regarding the procedure.”
Explanation of Adjustment:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
SCHOOL NAME__________________________________________________ EMPLOYER NUMBER____________________________________
EMPLOYER CONTACT SIGNATURE
DATE
Total Employee Contribution Adjustments (+/-)
Total Employer Contribution (+/-)
Total Adjustments
$______________
$______________
______________
Submitted via the web on the ____________/___________ Wage and Contribution Report
MONTH
YEAR
Check box if this is the result of NPERS audit
BEGIN
END
PREPARED BY
(FOR NPERS OFFICE USE ONLY)
NPERS6200 Rev. 12/2019 Page 1 of 1
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Adjustment Report - NPERS6200 ADJUSTMENT REPORT (Nebraska)

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Completed 19 May 2021

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