VACATION PAYOUT REQUEST

Eligible current regular full-time employees may request a vacation payout if employed with the Agency for a full 90 days. The vacation payout request may be made for a maximum of 80 hours and only vacation hours that have already been accrued are eligible. The vacation payout in wages is subject to federal tax withholding, in addition to social security, Medicare and applicable tax withholding. The following conditions apply to this option:

  • This request is a one-time request. (Must be elected by August 20, 2021, and will be included on the August 30, 2021, paycheck)
  • Only vacation leave may be used. (sick leave, reflection time, and personal time is not eligible)

Request Form

Name:
Email:
Program:
Vacation Balance (as of recent pay period):
Vacation Hours to be Paid Out:
I understand that my vacation leave balance will be decreased by that number of hours. I understand that this payment is considered taxable compensation and issubjectto all applicable income and employment tax withholding and all standard payroll deductions. I also understand that because this vacation payout ischaracterized as asupplemental wage payment for income tax purposes, a flat withholding rate will apply which may be higher or lower than the withholding rateapplicable to my regularwages. I further understand that this payment will be reported to Federal and state tax authorities on my 2021 IRS form W2.
Select to Agree:

The following is for use by HR staff only:

current vacation leave balance:
balance after payout:
approved and processed by:

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