Instructions for Completing Monthly Compensation Report for Assigned Judges (Retired)

1. Name and Address: List your name and address as it appears on your W-4 Form.
2. Report for Month/Year: List the month and year in which you performed the work, and for which the report is being submitted. You must submit at least one, but not more than two reports for each month. If necessary, use additional pages to complete your report. Reports must be sent no later than the end of the month following the month in which the work was performed. See Guidelines for Assignment of Judges, Guideline 14(B).
3. Date Worked: List the date(s) on which you performed assigned work. If you worked on more than one assignment on a date, list each assignment number on a separate line. If an assignment lasts more than one day, list each date on a separate line. Do not list dates that are not in the same month of the report.
4. Assignment Number: List the Supreme Court Assignment Number (for example: 05JA1234). Do not use the trial or appellate court case number.
5. Court of Assignment: List the name/number of the court/appellate district you were assigned to.
6. Hours Worked: List the number of hours that you worked on the case(s) corresponding to the assignment number listed on the same line. If you worked a portion of an hour, round up or down, as applicable, to the nearest full hour. If you worked on more than one case in an hour, with each case having a separate assignment number, fill in only the assignment number of the case on which you spent the most time. Do not fill in minutes or portions of an hour. Reports listing minutes or portions of an hour will be returned without compensation. See Guidelines for Assignment of Judges, Guideline 14(B).
7. Amount Due: Multiply the hours worked by one-eighth of the appropriate per diem rate corresponding to the assignment for that line. The total for one date may not exceed the per diem amount allowed, even if you worked more than eight hours. Total the Amount Due column for each page you submit as part of your report. See Guidelines for Assignment of Judges, Guideline 14(B).
8. Work Performed: Note the work you performed by checking all boxes that apply. See Guidelines for Assignment of Judges, Guideline 14(B).
9. Judge's Signature: Your signature certifying that the information provided is correct.
10. Date Signed: Date you reviewed and signed the report.
11. Page of Pages: List the number of each page and the total number of pages in your report.
12. Distribution of Copies: Retain the gold copy for your records. Return all other copies to the Supreme Court of Ohio, c/o Judicial Assignments, 65 South Front Street, 6^th Floor, Columbus, Ohio 43215-3431. Telephone: 614.387.9415.

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