To submit this form, deliver it to your payroll department via email or physically at your workplace. Ensure that the completed form is sent before the payroll cutoff date to guarantee that deductions are adjusted properly. For any questions regarding the submission process, contact your HR representative for assistance.

Important dates for this form will vary based on your employer's payroll schedule. Ensure you submit the form before your payroll deadlines to avoid delays. Always check with your HR department for specific timelines regarding salary deductions.

The Loan Repayment Salary Deduction Authorization Form serves to facilitate automatic deductions from employee salaries for loan repayments related to 403(b) and 457(b) retirement plans. By completing this form, employees authorize their employer to deduct specified amounts from their paychecks and direct them towards their retirement account loans. This process ensures timely repayments, helping employees manage their financial obligations effectively.

• 1. Employee Full Name: Field to enter the employee's full name.
• 2. Date of Birth: Field to enter the employee's date of birth.
• 3. Date of Hire: Field to indicate when the employee started their job.
• 4. Social Security Number: Field for the employee's social security number.
• 5. Contact Phone: Field to provide a contact phone number.
• 6. Email: Field for the employee's email address.
• 7. Loan Repayment Amount per Pay Period: Field to specify the deduction amount per pay period.
• 8. Effective Date of Change: Field to indicate when the deductions will begin.
• 9. Investment Provider: Section to name the provider accepting loan repayments.
• 10. Company Address: Field for the address of the investment company.
• 11. Cancellation Request: Section to request cancellation of deductions.
• 12. Employee Signature & Date: Fields for the employee to sign and date the authorization.
• 13. Employer Signature & Date: Fields for the employer to sign and date the form.

Failure to submit this form can result in the continuation of your current payroll deductions. Without authorization, repayments may not be processed, leading to potential penalties. It is crucial to ensure that this form is submitted to avoid unnecessary complications.

• Continued Deductions Without Changes: Your current deductions may continue if this form is not submitted.
• Penalties for Loan Non-Repayment: Failing to authorize deductions may lead to penalties on your loan.
• Delays in Repayment Processing: Repayment processing may be delayed until the form is submitted.

• 1. Establishing Salary Deductions: Utilize this form to set up new payroll deductions for a loan.
• 2. Modifying Existing Deductions: Use it to modify the amount being deducted from your salary.
• 3. Cancelling Deductions: Employ this form to cancel any existing salary deductions for your loan.