Page 1 of 7 s/users Additions, Changes or Deletions Request Company Code Company Name Name Telephone Number (111-111-1111) Email Address Case Number Please select the company code(s) that apply to your request in the left box and click the > button Effective Date:* Allow at least 72 hours > < Authorized Signature: Use this form to set up a new user that needs access to your ADP Applications (If you need to set up multiple users, please submit a separate request for each user): Complete the applicable section(s) for each main product that the new user needs access to, i.e. Payroll and/or Time and Attendance Management. In addition, complete the Admin Access section for every new user to indicate the ADP product and feature access applicable to this user. If you are replacing the current Primary contact, indicate what should be done with that contact. If there is no indication then the current Primary will be inactivated. Once inactivated, they will not be able to call ADP regarding the payroll. NOTE: Enter the first and last names exactly as they appear in the ADP system of record. First Name: Phone Number: Last Name: Fax Number: Email address: Title: For the following ADP Products contact needs to be made to arrange Legal Name / Company Address or Name changes ADP Product Number ADP401k Retirement Services 800-929-2170 ADP FSA Services 800-233-1457 ADP Unemployment Compensation Services 888-311-4313 ADP COBRA 866-618-1699 Payroll Requests Payroll Change/Addition Complete this section if you need to change or add a Payroll /User: (Allows ADP Client Services to release payroll and employee information over the phone or via email) Important Note:
Page 2 of 7 For the security of your account ADP will only accept a request to add an additional contact from an existing authorized contact. Users are not permitted to add themselves as a replacement to another user or as a new user. For each company code, one person can be assigned as the Primary person and multiple people can be Additional s. If the new Primary contact is not currently a listed contact for your company, you will need to submit two forms 1. Change Authorization form to Delete the previous Primary 2. Change Authorization form to Add the new Primary contact Additional Primary 3rd Party Click here if this is a New CPA Needs training Quickview Notification (only one contact per co code may receive Quickview) Note: Only one person can be assigned as a designee for each role below. Different people can be associated to the roles, and a form for new assignments will need to be submitted for each change. This contact should be set up with the following contact roles, select all that apply: (if none apply, select not applicable) Payroll Deliveries Decision Maker Quarter/Annual (if sent to a different address than the regular payroll delivery) Relationship Survey recipient Management (if sent to a different address than the regular payroll delivery) Not Applicable Payroll billing contact Only one contact name permitted for Tax Filing information- check this box ONLY if changing existing contact Note: For Tax Filing, both the Invoice and Correspondence Company Name and Address will default to the Legal Name and Address unless indicated differently below. Tax Filing (Legal ) Tax Filing (Invoice ) Tax Filing (Correspondence - Statement of Deposits/Filings and Tracer Response ) Additional Payroll Delivery Address New Address
Page 3 of 7 Old Address ReportNumberName Company Name Street City State Zip Attention ReportNumberName Company Name Street City State Zip Attention ReportNumberName Company Name Street City State Zip Attention Payroll Delete/Inactive- Complete this section if you need to delete/inactivate a Payroll /User: No information will be given to this employee. If the primary contact is being deleted a new primary contact must be designated. Please indicate if the primary contact being deleted should be saved as an additional contact. Employee has Admin Access Change the Primary to an Additional User Time & Attendance Management Requests Time & Attendance Management Change/AdditionComplete this section if you need to change or add a Time and Attendance /User: Time and Attendance automates the calculation and reporting of hours worked and paid time off based on your company's pay policies. Please verify your company's Time and Attendance product before making a selection.
Page 4 of 7 Type: Additional Primary CPA Product: Essential Time (EZLM) Expanded Time (e-time) Roles: Administrator Supervisor Manager IT Employee Time & Attendance Management Delete/InactiveComplete this section if you need to delete/inactivate a Time and Attendance /User: Time and Attendance automates the calculation and reporting of hours worked and paid time off based on your company's pay policies. Please verify your company's Time and Labor product before making a selection. No information will be given to this employee. If the primary contact is being deleted a new primary contact must be designated. Please indicate if the primary contact being deleted should be saved as an additional contact. Employee has Admin Access Product: Essential Time (EZLM) Expanded Time (e-time) Admin Access Admin Access - Complete this section to have Admin Access assigned to a user: (A request for administrator access will be completed by ADP if the user is an authorized contact. If the user is not currently an authorized contact, please complete the Payroll Change/Addition and/or Time & Attendance Management Request section(s) granting ADP to add this user as an authorized contact.) User Type - When users are granted admin access, we compare their proof of identity against data from ADP system(s) to confirm that they are the individuals they claim to be. If this is not an employee of your company and therefore not in your ADP system(s), select the Non-Employee option. This will grant the non-employee user admin access. Employee Non Employee Contractor Security Management User Role - Check one Client Security Role that applies to this new user: Security Master Security Admin Product User User Master User Administrator ADP Internet Products: Pay Statement Admin Payroll & Quarterly Tax Custom Learn@ADP Details ADP Region and PRS Locations: Central - 062 - (GMT 6:00) Central Time Dallas Houston General Ledger Report Support Center CD- ROM (DocuMax) Learn@ADP
Page 5 of 7 San Antonio Central - 069 - (GMT 6:00) Central Time Kansas City Minneapolis Omaha St. Louis Mid-Atlantic - 032 - (GMT 5:00) Eastern Time Charlotte Raleigh Mid-Atlantic - 052 - (GMT 5:00) Eastern Time Owings Mills Richmond Rockville Mid-Atlantic - 055 - (GMT 5:00) Eastern Time Monroe Township Fort Washington Midwest - 034 - (GMT 5:00) Eastern Time Cincinnati Cleveland Columbus Indianapolis Louisville Midwest - 060 - (GMT 6:00) Central Time Elk Grove Village Milwaukee Northeast - 010 - (GMT 5:00) Eastern Time Manchester Warwick Waltham Windsor Northeast - 056 - (GMT 5:00) Eastern Time Albany Williamsville Dearborn Grand Rapids Pittsburgh Northwest - 075 - (GMT 8:00) Pacific Time Milpitas
Page 6 of 7 Pleasanton San Francisco Northwest - 076 - (GMT 8:00) Pacific Time Clackamas Federal Way Lynnwood NY Metro - 020 - (GMT 5:00) Eastern Time Manhattan Parsippany NY Metro - 040 - (GMT 5:00) Eastern Time Melville Milford Southeast - 030 - (GMT 5:00) Eastern Time Atlanta Tampa Birmingham - (GMT 6:00) Central Time Memphis - (GMT 6:00) Central Time Nashville - (GMT 6:00) Central Time Southeast - 036 Miramar - (GMT 5:00) Eastern Time San Juan - (GMT 4:00) PR/VI Southwest - 070 -(GMT 8:00) Pacific Time La Palma San Diego Woodland Hills Hawaii - (GMT 10:00) Hawaii Southwest - 073 Denver - (GMT 7:00) Mountain Time Phoenix - (GMT 7:00) Arizona Tax Reporting Online / Agency Notice Manager TotalPay inet NOTE: Changes requested to TPINET, Tax Reporting Online / Agency Notice Manager will take seven (7) business days to complete. Payroll & Quarterly Tax Report Profile Options Admin Profile Has the ability to modify/restrict other users from viewing certain reports and company codes. The Admin would go to the Payroll & Quarterly Tax website to modify their other users access. User Profile Can only view what was granted to them by the Admin
Page 7 of 7 ADP Workforce Now Role: Standard Practitioner This user will be set up with access to all Portal menus. If you have any Custom Practitioner roles, you will need to make any necessary access restrictions within the WFN Portal! None "None" will not grant the user with any menu access until they are added to the appropriate practitioner group. Additional Comments or Details that pertain to Change V01.05.09