"Payroll Contribution Form" - Nevada

Payroll Contribution Form is a legal document that was released by the Nevada Department of Employment, Training and Rehabilitation - a government authority operating within Nevada.

Form Details:

  • Released on December 1, 2019;
  • The latest edition currently provided by the Nevada Department of Employment, Training and Rehabilitation;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Nevada Department of Employment, Training and Rehabilitation.

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Download "Payroll Contribution Form" - Nevada

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Clear Form
Payroll Contribution Form
__________________________________
______________________________
Name
Employee ID#
_________________________________
____________________________
Agency
Daytime Phone
Change Paycheck Deduction
New Paycheck Deduction **STOP HERE!!**
Increase, Decrease, Discontinue
**You must complete an EZ Enrollment form OR
Enroll Online with Voya Financial
to set up an account.
®
Please initial here if you enrolled online _______
State of Nevada
Political Subdivision
EMPLOYER:
(
City, County, Non-State)
PAYCHECK DEDUCTION AMOUNT:
I authorize my Employer to deduct the following amount(s) per pay period from my salary to NDC:
( Minimum $35.00 per pay period or $70.00 per month)
Pre-Tax (Regular)
Post-Tax (Roth)
____________
____________
If you wish to cancel/suspend current payroll deduction, please indicate $0. This form will supersede any
previous form(s) on file.
CHECK BOX IF APPLICABLE*:
Age 50+ Catch-Up
: Date of Birth _____/_____/_____
You must reach age 50 by the end of the calendar year you are electing to use this catch-up provision.
Special 457(b) Catch-Up Election
You must include a copy of the investment provider calculation sheet submitted to the recordkeeper
to ensure eligibility.
*Please note that you cannot use both the Age 50+ and the Special Catch-up provision at the same time. You need
to choose the option most beneficial to you.
EFFECTIVE DATE:
This agreement will be effective the first payroll period of the month following the date this form is
received and processed by the payroll department.
_______________________
Signature____________________________________________ Date
Please send the completed form to NDC
Fax: 775.684.3399
Email:
deferredcomp@defcomp.nv.gov
Voya Financial
1.866.464.6832
®
100 N. Stewart Street, Suite 100, Carson City, NV 89701
775.684.3397 | Fax 775.684.3399 | http://defcomp.nv.gov/
12/2019
Clear Form
Payroll Contribution Form
__________________________________
______________________________
Name
Employee ID#
_________________________________
____________________________
Agency
Daytime Phone
Change Paycheck Deduction
New Paycheck Deduction **STOP HERE!!**
Increase, Decrease, Discontinue
**You must complete an EZ Enrollment form OR
Enroll Online with Voya Financial
to set up an account.
®
Please initial here if you enrolled online _______
State of Nevada
Political Subdivision
EMPLOYER:
(
City, County, Non-State)
PAYCHECK DEDUCTION AMOUNT:
I authorize my Employer to deduct the following amount(s) per pay period from my salary to NDC:
( Minimum $35.00 per pay period or $70.00 per month)
Pre-Tax (Regular)
Post-Tax (Roth)
____________
____________
If you wish to cancel/suspend current payroll deduction, please indicate $0. This form will supersede any
previous form(s) on file.
CHECK BOX IF APPLICABLE*:
Age 50+ Catch-Up
: Date of Birth _____/_____/_____
You must reach age 50 by the end of the calendar year you are electing to use this catch-up provision.
Special 457(b) Catch-Up Election
You must include a copy of the investment provider calculation sheet submitted to the recordkeeper
to ensure eligibility.
*Please note that you cannot use both the Age 50+ and the Special Catch-up provision at the same time. You need
to choose the option most beneficial to you.
EFFECTIVE DATE:
This agreement will be effective the first payroll period of the month following the date this form is
received and processed by the payroll department.
_______________________
Signature____________________________________________ Date
Please send the completed form to NDC
Fax: 775.684.3399
Email:
deferredcomp@defcomp.nv.gov
Voya Financial
1.866.464.6832
®
100 N. Stewart Street, Suite 100, Carson City, NV 89701
775.684.3397 | Fax 775.684.3399 | http://defcomp.nv.gov/
12/2019