Carewell SEIU 503 Paid Time Off packet Logo
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  • Processing timeline of Paid Time Off (PTO) payments

     PTO and pay rate adjustments earned in one month are not reflected in your PTO earnings until the end of the following month.

    When you receive a wage increase, please make sure to account for this processing time for all future PTO benefit requests.

  • Paid Time Off Benefits Request

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  • Direct deposit form

    Fill out this form to sign up for direct deposit. Direct deposit is a faster and safer method than checks to get your PTO payments and reimbursements. Please provide us the following information, including a photo of a voided check. If you don't have a voided check, please submit a deposit statement from your bank or a letter from your bank with your account and routing numbers.
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  • Using the the tool below, you must submit a copy of a voided check; or a deposit statement from your bank with your account and routing numbers; or a letter from your bank with your account and routing numbers. 

    Directions on how to add files 
     
    If you DO have the files on your device: 
    1. Click on “Add Files” on this online form 
    2. Select the file(s) you would like to attach/upload 
     
    If you DON’T have the files on your device: 
    1. Use your phone to take a photo of any forms and documents that you need to send to us. Make sure to take a complete picture of the form and that your name is included. We can’t read or use blurry photos. 
    2. Click on “Add Files” on this online form 
    3. Select the file(s) you would like to attach/add 

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  • PTO Benefit Designation of Beneficiary

    Please complete this form to designate a beneficiary who you would like to receive your PTO benefits in the event that you pass away before receiving the benefits. You may designate one primary beneficiary, as well as one contingent beneficiary who will receive any available benefit in the event that your primary beneficiary predeceases you. Please provide the full name of your designated beneficiaries, as well as their addresses and their relationships to you.
  • By my signature below, I hereby designate the above individual as my Primary Beneficiary for the purpose of receiving any Carewell SEIU 503 Paid Time Off benefit payable on my behalf in the event of my death. Further, I hereby revoke any prior designation of Primary Beneficiary. I understand that this beneficiary designation will become effective only upon its receipt by the Benefits Administrative Office.

  • By my signature below, I hereby designate the above individuals as my Primary and Contingent Beneficiaries for the purpose of receiving any Carewell SEIU 503 Paid Time Off benefit payable on my behalf in the event of my death. Further, I hereby revoke any prior designation of Primary or Contingent Beneficiaries. I understand that these beneficiary designations will become effective only upon receipt by the Benefits Administrative Office.

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  • Form W-9: Request for Taxpayer Identification Number and Certification

    Go to www.irs.gov/FormW9 for instructions and the latest information.
  • 4. Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):

  • Part I - Taxpayer Identification Number (TIN)

  • Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your Social Security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.

  • Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

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  • I understand that by completing and signing this form I am requesting a taxable income benefit. I also understand that Paid Time Off (PTO) benefits will not be paid to me unless I have submitted a completed Form W-9 to Carewell SEIU 503 Benefits.

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  • In February-March and July-August, PTO Benefit Request Forms are processed once a month. Forms received by the 20th of the month will be processed for payment by the end of the month.

    For all other months, PTO Benefit Request Forms are processed on the following schedule:

    - Forms submitted by the 5th of the month will be processed for payment on the 15th of the month.
    - Forms submitted between the 6th and the 20th of the month will be processed for payment on the last Friday of the month.
    - Forms submitted after the 20th of the month will be processed for payment on the 15th of the following month.

    Please allow 5-10 business days for the payment to arrive.

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