Authorization for Pre-Tax Payroll Reduction Enrollment 2026

1. Click ‘Get Form’ to open the Authorization for Pre-Tax Payroll Reduction Enrollment in our editor.
2. Begin by filling out the 'Personal Information' section. Enter your name, employer, mailing address, city, state, zip code, Social Security Number (SSN), email, daytime phone number, and date of birth.
3. Next, move to the 'Payroll Information' section. Indicate how often you are paid by selecting one of the options: Weekly, Bi-Weekly, Monthly, Semi-Monthly, or Other. If applicable, specify if you are a Municipal or School Employee.
4. For Flexible Spending Accounts (FSA), enter the amount you wish to contribute for the Plan Year in the designated fields. Ensure that your contributions do not exceed IRS limits.
5. Complete the 'Direct Deposit Information' section if necessary. Provide your bank details including account type (checking or savings), bank name, routing number, and account number.
6. Finally, review and sign the certification statement at the bottom of the form. Make sure to date your signature before submitting.

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