Form P-4 - Employee Information And Voluntary Recurring Deductions - Comptroller General'S Office Page 2
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2Voluntary Recurring Deductions
Note: This form is to only be used for Voluntary Deductions offered by non-state third parties who have been assigned
a wage type code by the Office of the Comptroller General. Please contact your Benefits Administrator for any
deductions administered through PEBA, Great West, or FBMC. Please also note that you (Employee) may also make
the changes below within MySCEmployee.
Recurring Voluntary Deductions
Semi-Monthly
Deduction
Wage Type
Deduction Name
Amount
I hereby authorize my employer to deduct from my earnings the amounts indicated above to enable me to participate
in the above payroll deduction plans. I reserve the right to revoke the authorization at any time by giving written notice
to my employer or by making appropriate changes in MySCEmployee.
_________________________________
___________________________
Authorized Agency Signature
Date
_________________________________
___________________________
Employee’s Signature
Title
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