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U.S. Department of Health and Human Services

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Staff Manual Guide 2310.3, Attachment D

 

DEPARTMENT OF HEALTH OF HUMAN SERVICES

DATE:  
FROM:  
SUBJECT: LETTER OF NON-RECEIPT
TO: PAYROLL LIAISON (HFA-124)
  I, _______________________________, as of _________________________ have not
  received to my home address_________________________________________________
  _________________________________________________________________________
  the paycheck for pay period ending _____________________________________.
  I request that my check be reissued.

 

 

 

__________________________________________
Signature

 

 

__________________________________
Social Security Number