Fillable Fms Form 11-92 - Employee Information printable pdf download

Fms Form 11-92 - Employee Information

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F A S T S T A R T

Court Unit:

INSTRUCTIONS FOR PROCESSING FEDERAL EMPLOYEE PAYMENTS

Use: For processing Federal employee net salary, allotments, and other agency - approved payments associated with Federal employment (i.e.

travel reimbursement, uniform allowance, etc). Employee must complete items 1,2,3 and 5. Complete item 4 only if you want to start, cancel

or change the amount of a savings or discretionary allotment - see instructions on back of form.

1. EMPLOYEE INFORMATION

Note: If form lines print incorrectly, select "Print as Image" in print dialog box

(SSN) EMPLOYEE PAYROLL IDENTIFICATION NUMBER

EMPLOYEE NAME

(as on payroll records)

(Last, First, Initials)

TELEPHONE NUMBER (WORK)

(HOME)

2. TYPE OF ACCOUNT

3. DIRECT DEPOSIT ACCOUNT INFORMATION - NET PAY/TRAVEL/OTHER (Use Sec. 4 for allotments)

A voided personal check/sharedraft may be attached in lieu of completing this section.

Checking

See instructions on back of this form.

Savings

ROUTING TRANSIT

NUMBER

Check Digit

TYPE OF PAYMENT

ACCOUNT NUMBER

Net Pay

Travel

ACCOUNT TITLE ________________________________________________________________

(Account Holder’s Name)

Other Federal

employment related

FINANCIAL INSTITUTION NAME ____________________________________________________

payments

4. ALLOTMENT INFORMATION

Complete this section only if you want to start, cancel or change the amount of a savings or discretionary allotment - see instructions on back of form.

ACTION

AMOUNT

TYPE OF ALLOTMENT

TYPE OF ACCOUNT

(Check One)

INCREASE TO:

START

Savings (whole dollar amounts only)

SAVINGS

CANCEL

DECREASE TO:

Discretionary or Third Party