Forms

April 23, 2014

Forms	Instructions
At Your Service Password Reset Form	Self-explanatory
Employee DOMA FICA Consent Form (DOC)	DOMA Consent Form Instructions
I-9 Form (PDF)	Overview to Processing the I-9 Form Handbook for Employers (M-274) (PDF) Revised I-9 Handbook for Employers - Summary of Key Updates How to Complete Section 1 - for Employees Use Only (PDF)
I-9 Processor Form (PDF)	How to Complete the I-9 Processor Form
Information Gathering for Guardian Key Roles	Self-explanatory
Initial GLACIER Online Entry Form	Initial GLACIER Information Form Instructions
Late/Reduce Pay(EDLR) Worksheet (DOC)	How to Use the Late/Reduced (EDLR) Pay Worksheet
Oath & Patent Acknowledgement (PDF)	About the Oath and Patent Acknowledgement
Payroll Check Disposition Form (PDF)	Instructions on form
Payroll Feedback Form	Self-explanatory
Permission to Release Education Record	Self-explanatory
Pretax Transportation Benefit Disclaimer Form - 2014 (DOC)	Fax completed form to (310) 794-8751
Provisional Tax Statement Worksheet (DOC)	Provisional Tax Statement Worksheet Instructions
Remote Hire Authorized Agent Notice (PDF)	About the Remote Hire Authorized Agent Notice Form
Return Check for Reversal/Reduction Form (PDF)	PTR Manual, Section E8.4
States Withholding Requirements & Withholding Forms	Instructions available on each state's website
Unemployment Insurance Termination Report (PDF) Unemployment Insurance Claim Information Letter (PDF) California's Programs for the Unemployed (PDF)	About the Unemployment Insurance Termination Report
UPAY 830 - Out-f-State Income Tax Withholding Form (PDF)	UPAY 830 Instructions
UC W-4/DE 4 - Employee's Federal-State Withholding Allowance Certificate (PDF)	IRS instructions included. For additional instructions, refer to: EDB Manual, Section B11.3

Payroll Services
Phone: (310) 794-8752 | Fax: (310) 794-8751 | Mail Code: 141648

Payroll Services Hotline Hours
Monday – Friday 9 a. m. to Noon and 1 p.m. to 3 p. m.

Address

10920 Wilshire Boulevard, Suite 620
Los Angeles, CA 90024-6505

Office Hours

Monday – Friday 7:30 a. m. to 3 p. m.
Saturday and Sunday Closed