Savers Admin Payroll and Benefits Forms
1099 Info/Change Form
Complete for all new 1099 contractors.
Download: 1099 Contractor Info Form
Bonus Check Request Form
Use this form to request bonus checks.
Link: Bonus Check Request Form
COBRA Qualifying Event Notification Form (FSA Only)
Download: COBRA Qualifying Event Notification Form
Employee Info/Change Form
Complete for all new employees or for any demographic changes.
Download: Employee Info/Change Form
Evolution Remote Download Request Form
Request download instructions for Evolution’s Remote Client, our desktop payroll software. (For current clients only.)
FSA Benefit Card Request Form
Request additional FSA debit cards for your spouse or dependent child. (If you need to replace a lost card, please contact us at firstname.lastname@example.org.)
Download:FSA Benefit Card Request Form
FSA Change in Status Form
Report IRS-approved status changes.
Download: FSA Change in Status Form
FSA Dependent Care Account New Enrollee Worksheet
Calculate annual election for dependent care.
FSA Dependent Care Claim Form
Request reimbursement for your eligible dependent care expenses.
Download: FSA Dependent Care Claim Form
FSA Employee Guide
Request a full copy of our Flexible Spending Account employee guide.
Info Link: FSA Employee Guide
FSA/HRA Direct Deposit Authorization Form
Add or change direct deposits for flex or HRA.
FSA Medical Claim Form
Request reimbursement for your eligible medical expenses.
Download: FSA Medical Claim Form
FSA Medical New Enrollee Worksheet
Calculate annual election for medical FSA.
Download: FSA Medical New Enrollee Worksheet
FSA Participant Enrollment Form
Enroll in your company’s flex program.
Download: FSA Participant Enrollment Form
HRA Claim Form
Request reimbursement for eligible HRA (Health Reimbursement Account) expenses.
Download: HRA Claim Form
NC-4 EZ Form
Employees should use this form if they plan to claim the NC standard deduction and claim no tax credits or only the credit for children, if they qualify to claim exempt status, or if they prefer not completing the extended Form NC-4.
Download: NC-4 EZ Form
Extended withholding form which may provide more precise withholding figures, but will require historical tax return information and estimation of 2014 income, deductions, and credits from the employee.
Download: NC-4 Form
Federal withholding form and worksheet for employees.
Download: W-4 Form
Federal document used to obtain tax information for contractors and freelancers.
Download: W-9 Form