U. M. FDSP Associates, P.A.
EMPLOYEE PRE-TAX SALARY DEDUCTION AUTHORIZATION FORM
MTA Commuter Benefit Program Application
- We've teamed up with the MTA to offer you a new employee fringe benefit.
- Now, you can take advantage of reduced commute-to-work costs by using pre-tax salary deductions to purchase your MTA monthly pass right here at work!
- Each month, the cost of your pass (up to $50 tax-free to you) will be deducted from your paycheck before your earnings are taxed. This lowers your taxable income & saves money.
- The savings on the cost of your MTA monthly pass will range from $18 to $25 per month.
- By switching from driving to taking transit, you will save substantially more!
We encourage all of you to sign up for this excellent benefit by completing the authorization form below. YOU WILL SAVE MONEY!!
Name: SSN#:
Work Phone: Hire Date:
Department/Division/Office Where You Work:
Enroll in Employee Commuter Benefits Program
I authorize U.M. FDSP Associates, P.A. to have automatic deductions of $26.92taken out of my bi-weekly paycheck for the commuter pass and will remain in effect until I cancel with the Human Resources Department before the last payday of the month or my deduction will remain in effect until the following month. I understand that I will receive a MTA monthly commuter pass approximately the fourth week of every month available for pick-up in the Human Resources Office. I know I am responsible for picking up my pass and U.M. FDSP Associates, P.A. is not responsible should I lose or misplace my pass. No replacement or refund will be made to employee.
Signature Date
Cancel my Employee Commuter Pass
I authorize U.M. FDSP Associates, P.A. to stop of my $26.92payroll deduction for the commuter pass.
Signature Date
Authorized SignatureDate
U.M. FDSP Associates, P.A.