The Payroll Deduction - Special Services form authorizes an employee's payroll deduction for special services offered by their employer. This form is crucial for ensuring that payments for specific services are systematically deducted from an employee's paycheck. Unlike standard payroll deduction forms, this one specifically relates to additional services provided by the employer.
This form is used when an employee wishes to authorize payroll deductions for special services offered by a company. You may need this form if you are enrolling in optional health plans, wellness programs, or other employer-sponsored services that require direct payroll deductions.
This form is intended for:
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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

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If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

We protect your documents and personal data by following strict security and privacy standards.
Federal income tax withholding. Social Security & Medicare taxes also known as FICA taxes. State income tax withholding. Local tax withholdings such as city or county taxes, state disability or unemployment insurance. Court ordered child support payments.
Insurance premiums, union fees, and salary sacrifice payments are examples of private payroll deductions that are permitted when an agreement between an employer and an employee is in place. Payroll deductions can be compulsory or voluntary.
Debit "Wages Expense" for the full amount the company must pay for the pay period. Credit "Net Payroll Payable" and any deductions required. Add the total number of debits and then add the total number of credits.
Voluntary deductions are amounts which an employee has elected to have subtracted from gross pay. Examples are group life insurance, healthcare and/or other benefit deductions, Credit Union deductions, etc.Post tax deductions are withheld after all taxes have been calculated and withheld.
FICA tax. Federal Insurance Contributions Act (FICA) tax is made up of Social Security and Medicare taxes. Federal income tax. State and local taxes. Garnishments. Health insurance premiums. Retirement plans. Life insurance premiums. Job-related expenses.
The standard payroll deductions are those that are required by law. They include federal income tax, Social Security, Medicare, state income tax, and court-ordered garnishments.
Retirement or 401(k) plan contributions. Health insurance premiums for medical, dental and vision plans. Life insurance premiums. Contributions to a flexible spending account or pre-tax health savings plan.
Debit "Wages Expense" for the full amount the company must pay for the pay period. Credit "Net Payroll Payable" and any deductions required. Add the total number of debits and then add the total number of credits.
Federal Income Tax. State Income Tax. Social Security (FICA) Medicare Tax (FICA) Insurance Policy Deductions. Retirement Deductions.