EMPLOYER: P34 McGuire Bearing | PLAN YEAR: 11/1/2023 – 10/31/2024
Date of Birth:
Branch / Division:
Health Care Deduction: /per pay period // annually
Dependent Care Deduction: /per pay period // annually
I have read the enrollment material and understood its terms as they may apply to me. The amount deducted from my pay is not subject to Federal, State, or Social Security taxes. As a result, my Social Security retirement benefit may be affected. I cannot change or revoke my election during the plan year unless there is a change in my family status (e.g., birth or adoption of a child, marriage, divorce, death of a family member).
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Document Name: Health and Dependent Care Agreement
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