EFTA00181810



JFICER
DATE 7 12 4 109


# COURT-ORDERED PAYMENT SYSTEM
CHANGE FORM

# DOC #

## 1 Override Payment Undisbursed/Internal OP98 4 (Senior Clerk)

- Payee Name: [Name]
- Payee ID #: [ID #]
- Pfx #: [Pfx #]
- Seq #: [Seq #]
- Amount $: [Amount $]

Comment Code:

- Officer Initials:
- Supervisor Initials:
- Senior Clerk Initials:

## 2 Change Original Obligation Sentencing Authority-Ordered/COS Prepay OP98 1 (Lead Clerical)

- Payee Name: [Name]
- Payee ID #: [ID #]
- Pfx #: [Pfx #]
- Seq #: [Seq #]
- Amount $: [Amount $]

Comment Code: 609

Officer Initials: [Name]
Supervisor Initials: [Name]
Lead Clerical Initials: [Date]

## 3 EM Rate Change OP22 2 (CJIT)

- Effective Date: [Date]
- Number of Months New Rate In Effect: [Number of Months]
- - OR-:
- End Date of New Rate: [End Date of New Rate]
- Function = R:
- Reason Code:

Officer Initials:
Supervisor Initials:
Lead Clerical Initials:

## 4 Transfer Payment from One DC# Payee to Another (COPS Accounting)

- Amount of Payment $: [Amount of Payment $]
- Receipt Date: [Receipt Date]
- FROM: [From]
- DOC #: [DOC #]
- Payee ID #: [Payee ID #]
- Pfx #: [Pfx #]
- Seq #: [Seq #]

Comment Code:

- Officer Initials:
- Supervisor Initials:
- Senior Clerk Initials:

## 5 Delete Override OP98 4 (Senior Clerk)

- Payee Name: [Name]
- Payee ID #: [ID #
- Pfx #: [Pfx #
- Seq #: [Seq #
- Amount $: [Amount $]

Comment Code:

- Officer Initials:
- Supervisor Initials:
- Senior Clerk Initials:

## 6 Change to Obligation Correction/Input Error OP98 1 (Lead Clerical)

- Payee Name: [Name]
- Payee ID #: [ID #
- Pfx #: [Pfx #
- Seq #: [Seq #
- Amount $: [Amount $]

Comment Code:

- Officer Initials:
- Supervisor Initials:
- Senior Clerk Initials:

## 7 COS Rate Change OP22 2 (CJIT)

- Effective Date: [Date]
- Number of Months New Rate In Effect: [Number of Months]
- - OR-:
- End Date of New Rate: [End Date of New Rate]
- Function = R:
- Reason Code:

Officer Initials:
Supervisor Initials:
Lead Clerical Initials:

## 8 Refund/Overpayment to DC Payee (COPS Acctg Approval Request)

- Office Locator Code #: [Office Locator Code #]
- Offender Address: [Offender Address]
- City: [City]
- Pfx #: [Pfx #
- Seq #: [Seq #
- Amount $: [Amount $]

Comment Code:

- Officer Initials:
- Supervisor Initials:
- Senior Clerk Initials:

EFTA00181811