Employer, Employee & Contractor Information Sheets Page 5
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7Pay Frequency
Payday details
Date(s) or day(s) employees paid _______________________
Every Week
(for example, the 1
st
and 15
th
of the month)
Every Other Week
Twice a Month
Period Covered _______________________
Every Month
(for example, Paycheck on the 1
st
covers the 16
th
to the end of the prior
Other________
month)
Payroll Deductions
Select the voluntary deductions that apply and enter the $ or % amount to be deducted from each
paycheck.
Deduction
$ Amount or
Deduction
$ Amount or
% of Gross
% of Gross
Pre-tax medical
403(b)
Pre-tax vision
Simple IRA
Pre-tax dental
SARSEP
Taxable medical
Medical expense FSA
Taxable vision
Dependent care FSA
Taxable dental
Loan Repayment
401(k)
Cash Advance
Repayment
Simple 401(k)
Other __________
Is this employee subject to wage garnishments, such as a federal tax or child support garnishment?
Yes
If so, attach copies of all garnishment orders
No
Sick and Vacation
If this employee earns paid time off, complete the section below; otherwise, leave blank.
Sick Pay
Vacation Pay
No. of Hours Earned Per Year
________
No. of Hours Earned Per Year
________
Max. hours accrued per year (if any)
________
Max. hours accrued per year (if any)
________
Current Balance
________
Current Balance ________
Hours are accrued:
Hours are accrued:
As a lump sum at the beginning of year
As a lump sum at the beginning of year
Each pay period
Each pay period
Each hour worked
Each hour worked
Notes
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Parent category: Business