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403b Information

2022-2023 Payroll

Benetech Starting Guide
File Size:	44 kb
File Type:	docx

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2022 Federal Withholding Certificate
File Size:	1696 kb
File Type:	pdf

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Benetech 403b Provider List
File Size:	22 kb
File Type:	docx

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2022 New York State Withholding Certificate
File Size:	4426 kb
File Type:	pdf

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Benetech Salary Reduction Agreement
File Size:	515 kb
File Type:	pdf

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PR-06 Direct Deposit
File Size:	234 kb
File Type:	pdf

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Universal Availability Mailer 2022
File Size:	35 kb
File Type:	doc

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Flexible Spending 2023

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Health Reimbursement Forms 

BT HRA Expense Recovery Form Revised- March 2022
File Size:	581 kb
File Type:	pdf

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2022 Participant Direct Deposit Authorization Form
File Size:	83 kb
File Type:	pdf

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Direct Deposit Form
File Size:	45 kb
File Type:	pdf

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2022 FSA Eligible
File Size:	164 kb
File Type:	pdf

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FSA HRA Eligible List
File Size:	100 kb
File Type:	pdf

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2022 5 New Eligible Expenses Cares Act
File Size:	276 kb
File Type:	pdf

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HRA Enrollment Form
File Size:	14 kb
File Type:	pdf

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App Scanner
File Size:	424 kb
File Type:	pdf

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HRA Mobile App Overview
File Size:	314 kb
File Type:	pdf

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Benetech Mobile App Mailer
File Size:	313 kb
File Type:	pdf

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BT FSA Medical Expense Claim Form Revised- March 2022
File Size:	581 kb
File Type:	pdf

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Health Insurance Forms 

APPR forms

Declination Form
File Size:	48 kb
File Type:	docx

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Final Pre-Observation Form
File Size:	36 kb
File Type:	docx

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Final Post Observation Form
File Size:	39 kb
File Type:	docx

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Class Profile Form
File Size:	29 kb
File Type:	docx

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