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LHi AaBJ#h1hoIENDB`3 A@@  P Q5 First Name Last NameMIUT-EIDAddress Line 1Address Line 2CityState Zip Code Home Phone Work Phone Email AddressEmployee SignatureDateDate of Birth (mm/dd/yyyy) Student (Y/N)'Please read and sign before submitting: CardholderBT H E U N I V E R S I T Y O F T E X A S A T E L P A S O Mail Order Bulk upload Issue Type:Ship To: Check List:Date:Social Security # 1) Submitted in PAT 2) Entered in BIS-OF3 3) Entered in BIS-PS1 4) Print Card Receipt Payroll Office(Employee must activate card upon receipt_For address information, please DO NOT USE: (1)PO Box, (2)Foreign Address, or (3)Campus Address?F O R U S E B Y P A Y R O L L S E R V I C E S O N L YAccount # / Confirmation # 1. With a few exception, you are entitled on your request to be informed about the information the JAVŮŹ of Texas at El Paso collects about you. 2. Under section 552.021 and 552.023 of the Texas Government Code, you are entitled to receive and review the information; and(E M P L O Y E E I N F O R M A T I O NPay Card Enrollment Form 3. Under section 559.004 of the Texas Government Code, you are entitled to have the JAVŮŹ of Texas at El Paso correct the information about you that is held by us and and that is incorrect, in accordance with the procedures set fourth in the JAVŮŹ of Texas System Business Procedures Memorandum 32, Texas Public Information Act.The information the JAVŮŹ of Texas at El Paso collects will be retained and maintained as required by Texas records retention laws (Section 441.180 et. Seq. of the Texasf Government Code) and rules. Different types of information are kept for different periods of time. credit any amounts owed to me, as instructed by my employer, by initiating credit entries to my Total Pay Card. In the event that ADP loads funds erroneously to my Total Pay Card, I authorize ADP and my employer to debit my card for an amount not to exceed the original amount of the erroneous credit. This authorization is to remain in full force and effect until ADP has received written notice from me of its termination in such time and in such manner as to afford ADP reasonable opportunity to act on it.cPay Card will be mailed to the address on the Enrollment Form and should be received with in 7 days By accepting and using my Total Pay Card, I agree to be bound by the terms and conditions outlined in the Total Pay Card Cardholder Agreement. 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