Payroll and benefits information and forms

Links to forms related to payroll and benefits are listed below for your convenience.

Adjunct academic employee leave report  CCS 1675

Affidavit of lost/destroyed check  
(SBCTC)
Complete this form to have a payroll check reissued.  Must be notarized.  See Paycheck FAQs for information regarding the mandatory waiting period.  Following is a link to a list of CCS Notary Publics

Classified employee time sheet CCS 1647
Complete this form to report hours if the reporting period is outside the online time certification period, or if extending beyond your normal cyclic calendar.

Direct deposit application  CCS 2613
Complete this form to have direct deposit to your bank.

Employee address change form CCS 2144 | Word version

Foundation employee pledge form 
CCS 1827
Complete this form to make a payroll deduction pledge to the CCS Foundation.  If you need assistance choosing a fund, please contact the foundation office at 434-5123.

Health Savings Account (HSA) CCS 2615
HSAs are attached to Consumer-Directed Health Plans (CDHP) only.  For more information on HSAs, see the HealthEquity web page.

Notification of ability to average  CCS 2153

Notification of payroll overpayment, nonrepresented 
CCS 2142

Payroll deduction authorization for annual parking permit  CCS 2614

CCS employee tuition waiver form CCS 40-130
For eligible employees, complete this form to have the tuition waived for up to six (6) credits taken at CCS or another eligible institution.  Must be signed by your supervisor and sent to HR.

Verification of student status at public college or university other than CCS  CCS 2150

Weekly time & effort report 
CCS 2139

Workstudy notification of ineligibility for membership in the Washington State Retirement System  CCS 2149

W-4 employee's withholding allowance certification 
IRS-W4
Complete this form if you wish to change your payroll deductions for federal taxes.

MEDICAL INSURANCE
2014 Employee Enrollment / Change form
2013 Employee Enrollment / Change form
Dependent Verification

LIFE INSURANCE
Life Insurance Enrollment / Change form
Life Insurance Evidence of Insurability form
Life Insurance Conversion
Change of Beneficiary

LONG-TERM DISABILITY
Long Term Disability Enrollment / Change form
Long Term Disability Evidence of Insurability form


VEBA
All participant forms can be downloaded as fillable PDFs from the VEBA website

VEBA Enrollment form
Claim Form for expenses
Account Change form
Direct Deposit Enrollment form
Systematic Premium Reimbursement form
Election of Limited VEBA Plan Coverage form


FLEXIBLE SPENDING / DEPENDENT CARE
2014 Flex Plan Information
All FSA & DCAP forms
2013 FSA & DCAP Enrollment
2013 Enrollment Guide
2013 FSA & DCAP Claim form



RETIREMENT
Basic TIAA/CREF retirement plan salary reduction agreement
Voluntary salary reduction agreement
DRS member information form
DRS beneficiary designation form
DRS name/address change form
DRS retirement status form

DCP participation agreement form