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Seniors and People with Disabilities Division Independent Choices Program Form Blank Pay Stub Pay period begins D/M/Y Employee s Name Pay period ends D/M/Y Rate of Pay Regular Total Gross Wages Deductions FICA Other Hours Pay Day Check Net Pay Form SPD IC Pay Stub ver04.
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Regular Total Gross Wages Deductions FICA Other Pay Day: Employees Name Total Check Net Pay # Pay period begins (D/M/Y): Rate of Pay period ends (D/M/Y): Hours Regular Total Gross Wages Deductions FICA Other Pay Day: Employees Name Total Check Net Pay # Pay period begins (D/M/Y): Rate of Pay period ends (D/M/Y): Hours Regular Total Gross Wages Deductions FICA Other Pay Day: Employer's Name Total Check Net Pay # Pay period begins (D/M/Y): Rate of Pay period ends (D/M/Y): Hours Regular Total Gross Wages Deductions FICA Other Pay Day: Employer's Name Total Check Net Pay # Pay period begins (D/M/Y): Rate of Pay period ends (D/M/Y): Hours Regular Total Gross Wages Deductions FICA Other Pay Day: Employer's Name Total Check Net Pay # Pay period begins (D/M/Y): Rate of Pay period ends (D/M/Y): Hours Regular Total Gross Wages Deductions FICA Other Pay Day: Payment Options Our office does not provide credit cards, student loans, or employer loans. You may be able to obtain a business credit card. We accept VISA, MasterCard, and Discover. You must be at least 18 years old to apply. You will be notified once your application has been received and reviewed. Your credit information will be checked for accuracy. The average wait time between application submissions and payment is 4 to 5 business days. How to Submit a Claim You must complete the Business and Occupation Tax Withholding Request form, available at the California Employment Development Department. This form must be submitted before your employer will pay any payroll tax withholding. You must complete the form each time an employer has required you to submit a payroll tax return. The California Employment Development Department uses the IRS tax withholding calculator when completing the wage and tax withholding statement for your employees. You will need to complete the calculator to determine the amount. Please be aware that a payroll tax withholding of 1,000.00 will not be withheld from any employee's paycheck unless the employer has made a federal tax withholding of 1,000.00 or greater.
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