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2014 irs form 8917 2015

2014 irs form 8917 2015-2026

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The document is an Enrollment/Waiver Form for the Paychex Premium Only Plan, intended for both payroll and non-payroll clients. It outlines the process for employees to elect participation in a premium payment plan on a pretax basis or opt out for after-tax payments. The form requires employer and employee information, details about health, dental, and life benefits, and includes guidelines on changing elections and participation terms.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information in the designated fields, including your name and Social Security Number. Ensure accuracy as this information is crucial for tax processing.
Next, indicate your election to participate in the Premium Only Plan by checking the appropriate box. This decision affects how your premium payments are taxed.
Complete the Employee Enrollment Information section. Fill in the enrollment date and first check date, along with deduction frequency based on your pay periods.
For each benefit type (Health, Dental, Life, Other), input the per-pay-period amount and number of pay periods to calculate your annual premium. Double-check these calculations for accuracy.
Finally, sign and date the form at the bottom to validate your enrollment or waiver choice before submitting it through our platform.

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