1.	Pay period start date:
2.	Pay period end date:
3.	Total work days:
4.	Effective date of funding change:
5.	Days worked at 1st funding and rate:
6.	Days worked at 2nd funding and rate:
7.	Amount per-pay period 1st part:	$
8.	Amount per-pay period 2nd part:	$

9.	Fund	% 1st Part	% 2nd Part