Fill - Free fillable COMMUNITY COLLEGE OF ALLEGHENY COUNTY (Community College of Allegheny County) PDF form

COMMUNITY COLLEGE OF ALLEGHENY COUNTY

New Hire

Packet

AN EQUAL EMPLOYMENT

OPPORTUNITY EMPLOYER

Rev 1.04.21

COMMUNITY COLLEGE OF ALLEGHENY COUNTY

NEW EMPLOYEE INFORMATION

Please clearly print or type all information.

Employee Name ______________________________________

Social Security Number ____________________ Birth date ___________________

Address _____________________________________________ Home Phone_______________

City _____________________________ State ____________________ Zip _______________

Employee’s Position Title _____________________________________Job Slot ______________

Email Address (CCAC) __________________________ (Personal) ____________________________

Department _____________________________ Office Telephone # ________________________

Campus: Allegheny_____ Boyce_____ Office of College Svs_____ South_____ North_____

Paystub Preference Office Location (Building & Room) ________________

CCAC REPRESENTATIVE INFORMATION (REQUIRED)

Supervisor/Hiring Administrator Name ____________________________ Phone # ______________

Support Staff Person’s Name

Submitting This Form (if applicable) _________________________________ Phone # ______________

PACKET TO BE COMPLETED AND SUBMITTED AT EMPLOYEE PROCESSING

CENTER (EPC)

No Employee shall begin work until the new employee hire packet, I-9, clearances and

internal personnel action request is completed and approved as applicable. Section 1

of the online I-9 Document (Employment Eligibility Verification) must be completed by

the employee on or before the first day and Section 2 completed by designated I-9

gatekeeper no later than the 3

business day of the employee’s start date.

Information for work-study students shall be maintained by the Campus Financial Aid

Office.

View online

Mail to home

Mail to Campus

mailbox

COMMUNITY COLLEGE OF ALLEGHENY COUNTY

NEW HIRE AGREEMENT FORM

Please clearly print or type all information.

Employee Name _________________________________________ Date ____________________

Colleague ID ____________________ Birth date _________________

Please note the following requirements of employment and initial each item below as acknowledgement and

understanding of the statement:

_____ I am required to complete the clearance process as outlined on the linked pages from

www.ccacjobs.com prior to my first day of employment. The FBI clearance process includes an

online process, providing a physical set of fingerprints and may take several weeks to process.

_____ I will be enrolled in first week orientation courses assigned through the Learning Communities.

This course includes an acknowledgement form for reading our Employee Manual. The

completion date for the course will be 7 days after my date of hire.

_____ Depending on my role at the college, for up

to 1 year I may be enrolled in a series of

online orientation courses assigned through

the Learning Communities.

_____ I will check my ccac.edu email account daily

during my employment.

_____ Please list any names other than the name

listed above that may be listed on transcripts.

______________________________________________________________

Initial the appropriate option:

_____ CCAC is my only employer

_____ CCAC is not my only employer. I am providing the info below to comply with the Employee

Manual, 5.19.5 Secondary Employment Report All secondary employment for a regular College

employee must be reported to the appropriate Campus President Vice President and the Vice

President for Human Resources and must not be in conflict with the employee’s responsibilities

to the College.

_______________________________________________ Other Employer(s)

_______________________________________________ Hours/week

NOTE: You will be notified of your

enrollment in courses through your

ccac.edu email account. You may also log

into the Learning Communities using the

My.CCAC.edu portal. If you do not have

access to email or MyCCAC portal, advise

your supervisor and contact the ITS service

desk at 412-237-8700 or

help@servicedesk.ccac.edu

NEW HIRE PACKET CHECKLIST

THE FOLLOWING MUST BE COMPLETED OR REVIEWED PRIOR TO SENDING TO THE

CAMPUS BUSINESS OFFICE AND BEFORE PROCESSING ANY EMPLOYEE’S PAYROLL

(Place “X” in box for completed, or reviewed where indicated)

A. Clearances

Clearances are required for all new hires. Directions for completion of clearances are

online at www.ccacjobs.com under menu: “Information about PA Act 153 Clearances”.

B. Employment

Application

The employment application is to be completed by all employees by using the online

application system on www.ccacjobs.com. Persons hired not for a specific posting or

applicant pool should apply to a posting called “General Application” by searching via

keyword on job site, if directed to do so by a CCAC representative.

C. Network Account

Request

Request network/email account for adjunct faculty, temporary part-time, or work-study

employees by searching “Network Account Request” on www.ccac.edu by completing

and submitting the form. Note: Human Resources completes this process for

employees hired into benefit-eligible positions.

D. Employment

Eligibility Verification

Form I-9

Complete I-9 with designated I-9 “gatekeeper” using the Employment Eligibility

Verification Form on-line. The employee must complete Section 1 on or prior to the first

day of employment. The remainder of the I-9 must be completed no later than the third

business day from the first day of employment.

*If the employee selects “An alien authorized to work until…” in section 1 of the I-9, the

person will also need to complete, and include with the new hire packet, the “Foreign

National Information Form” available online:

https://www.ccac.edu/Payroll_Department.aspx under “forms”

E. Employee’s

Withholding

Allowance Certificate

Form W-4

The W-4 form is to be completed by all employees. Employees claiming exemption

from withholding must complete a new form each calendar year. NOTE: If there is a

change in the employee’s number of allowances or amount of withholding, a new W-4

form is required for the change to become effective.

F. Local Earned

Income Tax

Residency

Certification Form

This form (formerly emergency & municipal services tax) is required by Pennsylvania

Act 32 of 2008 and is to be used to report essential information for the collection and

distribution of Local Earned Income Taxes. Any employee who changes their home

address or primary work location is required to complete a new certificate of residency

form.

G. Local Services

Tax Exemption

Section E only needs to be completed if exempt. All employees must pay the Local

Services Tax unless they are exempt. Reasons for exemption include: (1) Primary

employer is deducting, (2) Low Earnings [under $12,000], (3) Active Military, or (4)

Disabled Military. If no exemptions apply the tax will be deducted from each pay.

H. Direct Deposit

New employees can have their pay deposited directly into their checking or savings

account. The employee must notify Payroll immediately when the account is closed or

account/routing numbers are changed.

I. Sexual Harassment

Acknowledgement

Please read and sign the Sexual Harassment Acknowledge Letter and have an

employer representative sign as a witness.

J. Colleague/

Network

Confidentiality

All new employees who will have access to Colleague and/or the CCAC network must

read and sign this form. Records will be kept on file in Human Resources.

K. Worker’s

Compensation

This form, including employee’s acknowledgment of rights and duties, needs to be

signed by all new employees. A copy of this form will be retained in personnel file.

L. Health

Marketplace Options

Reviewed by employee. These documents must be provided to new hires.

M. 403B Elective

Deferrals – Universal

Availability Notice

Reviewed by employee. These documents must be provided to new hires.

Form W-4

(Rev. December 2020)

Department of the Treasury

Internal Revenue Service

Employee’s Withholding Certificate

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.

Give Form W-4 to your employer.

Your withholding is subject to review by the IRS.

OMB No. 1545-0074

2021

Step 1:

Enter

Personal

Information

(a) First name and middle initial Last name

Address

City or town, state, and ZIP code

(b) Social security number

Does your name match the

name on your social security

card? If not, to ensure you get

credit for your earnings, contact

SSA at 800-772-1213 or go to

www.ssa.gov.

(c)

Single or Married filing separately

Married filing jointly or Qualifying widow(er)

Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can

claim exemption from withholding, when to use the estimator at www.irs.gov/W4App, and privacy.

Step 2:

Multiple Jobs

or Spouse

Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse

also works. The correct amount of withholding depends on income earned from all of these jobs.

Do only one of the following.

(a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or

(b)

Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or

(c)

If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option

is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld .....

TIP: To be accurate, submit a 2021 Form W-4 for all other jobs. If you (or your spouse) have self-employment

income, including as an independent contractor, use the estimator.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will

be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)

Step 3:

Claim

Dependents

If your total income will be $200,000 or less ($400,000 or less if married filing jointly):

Multiply the number of qualifying children under age 17 by $2,000

Multiply the number of other dependents

by $500 . . . .

Add the amounts above and enter the total here .............

3 $

Step 4

(optional):

Other

Adjustments

(a)

Other income (not from jobs). If you want tax withheld for other income you expect

this year that won’t have withholding, enter the amount of other income here. This may

include interest, dividends, and retirement income . . . . . . . . . . . .

4(a) $

(b) Deductions. If you expect to claim deductions other than the standard deduction

and want to reduce your withholding, use the Deductions Worksheet on page 3 and

enter the result here .....................

4(b) $

4(c)

Step 5:

Sign

Here

Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

Employee’s signature (This form is not valid unless you sign it.)

Date

Employers

Only

Employer’s name and address First date of

employment

Employer identification

number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 3.

Cat. No. 10220Q

Form W-4 (2021)

Page 2

General Instructions

Future Developments

For the latest information about developments related to

Form W-4, such as legislation enacted after it was published,

go to www.irs.gov/FormW4.

Purpose of Form

Complete Form W-4 so that your employer can withhold the

correct federal income tax from your pay. If too little is

withheld, you will generally owe tax when you file your tax

return and may owe a penalty. If too much is withheld, you

will generally be due a refund. Complete a new Form W-4

when changes to your personal or financial situation would

change the entries on the form. For more information on

withholding and when you must furnish a new Form W-4,

see Pub. 505, Tax Withholding and Estimated Tax.

Exemption from withholding. You may claim exemption

from withholding for 2021 if you meet both of the following

conditions: you had no federal income tax liability in 2020

and you expect to have no federal income tax liability in

2021. You had no federal income tax liability in 2020 if (1)

your total tax on line 24 on your 2020 Form 1040 or 1040-SR

is zero (or less than the sum of lines 27, 28, 29, and 30), or

(2) you were not required to file a return because your

income was below the filing threshold for your correct filing

status. If you claim exemption, you will have no income tax

withheld from your paycheck and may owe taxes and

penalties when you file your 2021 tax return. To claim

exemption from withholding, certify that you meet both of

the conditions above by writing “Exempt” on Form W-4 in

the space below Step 4(c). Then, complete Steps 1(a), 1(b),

and 5. Do not complete any other steps. You will need to

submit a new Form W-4 by February 15, 2022.

Your privacy. If you prefer to limit information provided in

Steps 2 through 4, use the online estimator, which will also

increase accuracy.

As an alternative to the estimator: if you have concerns

with Step 2(c), you may choose Step 2(b); if you have

concerns with Step 4(a), you may enter an additional amount

you want withheld per pay period in Step 4(c). If this is the

only job in your household, you may instead check the box

in Step 2(c), which will increase your withholding and

significantly reduce your paycheck (often by thousands of

dollars over the year).

When to use the estimator. Consider using the estimator at

www.irs.gov/W4App if you:

1. Expect to work only part of the year;

2. Have dividend or capital gain income, or are subject to

additional taxes, such as Additional Medicare Tax;

3. Have self-employment income (see below); or

4. Prefer the most accurate withholding for multiple job

situations.

Self-employment. Generally, you will owe both income and

self-employment taxes on any self-employment income you

receive separate from the wages you receive as an

employee. If you want to pay these taxes through

withholding from your wages, use the estimator at

www.irs.gov/W4App to figure the amount to have withheld.

Nonresident alien. If you’re a nonresident alien, see Notice

1392, Supplemental Form W-4 Instructions for Nonresident

Aliens, before completing this form.

Specific Instructions

Step 1(c). Check your anticipated filing status. This will

determine the standard deduction and tax rates used to

compute your withholding.

Step 2. Use this step if you (1) have more than one job at the

same time, or (2) are married filing jointly and you and your

spouse both work.

Option (a) most accurately calculates the additional tax

you need to have withheld, while option (b) does so with a

little less accuracy.

If you (and your spouse) have a total of only two jobs, you

may instead check the box in option (c). The box must also

be checked on the Form W-4 for the other job. If the box is

checked, the standard deduction and tax brackets will be

cut in half for each job to calculate withholding. This option

is roughly accurate for jobs with similar pay; otherwise, more

tax than necessary may be withheld, and this extra amount

will be larger the greater the difference in pay is between the

two jobs.

CAUTION

Multiple jobs. Complete Steps 3 through 4(b) on only

one Form W-4. Withholding will be most accurate if

you do this on the Form W-4 for the highest paying job.

Step 3. This step provides instructions for determining the

amount of the child tax credit and the credit for other

dependents that you may be able to claim when you file your

tax return. To qualify for the child tax credit, the child must

be under age 17 as of December 31, must be your

dependent who generally lives with you for more than half

the year, and must have the required social security number.

You may be able to claim a credit for other dependents for

whom a child tax credit can’t be claimed, such as an older

child or a qualifying relative. For additional eligibility

requirements for these credits, see Pub. 972, Child Tax

Credit and Credit for Other Dependents. You can also

include other tax credits in this step, such as education tax

credits and the foreign tax credit. To do so, add an estimate

of the amount for the year to your credits for dependents

and enter the total amount in Step 3. Including these credits

will increase your paycheck and reduce the amount of any

refund you may receive when you file your tax return.

Step 4 (optional).

Step 4(a). Enter in this step the total of your other

estimated income for the year, if any. You shouldn’t include

income from any jobs or self-employment. If you complete

Step 4(a), you likely won’t have to make estimated tax

payments for that income. If you prefer to pay estimated tax

rather than having tax on other income withheld from your

paycheck, see Form 1040-ES, Estimated Tax for Individuals.

Step 4(b). Enter in this step the amount from the Deductions

Worksheet, line 5, if you expect to claim deductions other than

the basic standard deduction on your 2021 tax return and

want to reduce your withholding to account for these

deductions. This includes both itemized deductions and other

deductions such as for student loan interest and IRAs.

Step 4(c). Enter in this step any additional tax you want

withheld from your pay each pay period, including any

amounts from the Multiple Jobs Worksheet, line 4. Entering an

amount here will reduce your paycheck and will either increase

your refund or reduce any amount of tax that you owe.

Form W-4 (2021)

Page 3

Step 2(b)—Multiple Jobs Worksheet (Keep for your records.)

If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE

Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job.

Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional

tables; or, you can use the online withholding estimator at www.irs.gov/W4App.

Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have one

job, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the

“Lower Paying Job” column, find the value at the intersection of the two household salaries and enter

that value on line 1. Then, skip to line 3 ..................... 1

2 Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and

2c below. Otherwise, skip to line 3.

Find the amount from the appropriate table on page 4 using the annual wages from the highest

paying job in the “Higher Paying Job” row and the annual wages for your next highest paying job

in the “Lower Paying Job” column. Find the value at the intersection of the two household salaries

and enter that value on line 2a ....................... 2a

Add the annual wages of the two highest paying jobs from line 2a together and use the total as the

wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower

Paying Job” column to find the amount from the appropriate table on page 4 and enter this amount

on line 2b .............................

2b $

c Add the amounts from lines 2a and 2b and enter the result on line 2c .......... 2c

3 Enter the number of pay periods per year for the highest paying job. For example, if that job pays

weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc. ..... 3

Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this

amount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additional

amount you want withheld) ......................... 4 $

Step 4(b)—Deductions Worksheet (Keep for your records.)

Enter an estimate of your 2021 itemized deductions (from Schedule A (Form 1040)). Such deductions

may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to

$10,000), and medical expenses in excess of 7.5% of your income ............ 1

2 Enter:

{

• $25,100 if you’re married filing jointly or qualifying widow(er)

• $18,800 if you’re head of household

• $12,550 if you’re single or married filing separately

}

........ 2 $

3 If line 1 is greater than line 2, subtract line 2 from line 1 and enter the result here. If line 2 is greater

than line 1, enter “-0-” .......................... 3

4 Enter an estimate of your student loan interest, deductible IRA contributions, and certain other

adjustments (from Part II of Schedule 1 (Form 1040)). See Pub. 505 for more information .... 4

5 Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4 ........... 5 $

Privacy Act and Paperwork Reduction Act Notice. We ask for the information

on this form to carry out the Internal Revenue laws of the United States. Internal

Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to

provide this information; your employer uses it to determine your federal income

tax withholding. Failure to provide a properly completed form will result in your

being treated as a single person with no other entries on the form; providing

fraudulent information may subject you to penalties. Routine uses of this

information include giving it to the Department of Justice for civil and criminal

litigation; to cities, states, the District of Columbia, and U.S. commonwealths and

possessions for use in administering their tax laws; and to the Department of

Health and Human Services for use in the National Directory of New Hires. We

may also disclose this information to other countries under a tax treaty, to federal

and state agencies to enforce federal nontax criminal laws, or to federal law

enforcement and intelligence agencies to combat terrorism.

You are not required to provide the information requested on a form that is

subject to the Paperwork Reduction Act unless the form displays a valid OMB

control number. Books or records relating to a form or its instructions must be

retained as long as their contents may become material in the administration of

any Internal Revenue law. Generally, tax returns and return information are

confidential, as required by Code section 6103.

The average time and expenses required to complete and file this form will vary

depending on individual circumstances. For estimated averages, see the

instructions for your income tax return.

If you have suggestions for making this form simpler, we would be happy to hear

from you. See the instructions for your income tax return.

Form W-4 (2021)

Page 4

Married Filing Jointly or Qualifying Widow(er)

Higher Paying Job

Annual Taxable

Wage & Salary

Lower Paying Job Annual Taxable Wage & Salary

$0 -

9,999

$10,000 -

19,999

$20,000 -

29,999

$30,000 -

39,999

$40,000 -

49,999

$50,000 -

59,999

$60,000 -

69,999

$70,000 -

79,999

$80,000 -

89,999

$90,000 -

99,999

$100,000 -

109,999

$110,000 -

120,000

$0 - 9,999 $0 $190 $850 $890 $1,020 $1,020 $1,020 $1,020 $1,020 $1,100 $1,870 $1,870

$10,000 - 19,999

190 1,190 1,890 2,090 2,220 2,220 2,220 2,220 2,300 3,300 4,070 4,070

$20,000 - 29,999 850 1,890 2,750 2,950 3,080 3,080 3,080 3,160 4,160 5,160 5,930 5,930

$30,000 - 39,999

890 2,090 2,950 3,150 3,280 3,280 3,360 4,360 5,360 6,360 7,130 7,130

$40,000 - 49,999

1,020 2,220 3,080 3,280 3,410 3,490 4,490 5,490 6,490 7,490 8,260 8,260

$50,000 - 59,999 1,020 2,220 3,080 3,280 3,490 4,490 5,490 6,490 7,490 8,490 9,260 9,260

$60,000 - 69,999

1,020 2,220 3,080 3,360 4,490 5,490 6,490 7,490 8,490 9,490 10,260 10,260

$70,000 - 79,999

1,020 2,220 3,160 4,360 5,490 6,490 7,490 8,490 9,490 10,490 11,260 11,260

$80,000 - 99,999 1,020 3,150 5,010 6,210 7,340 8,340 9,340 10,340 11,340 12,340 13,260 13,460

$100,000 - 149,999

1,870 4,070 5,930 7,130 8,260 9,320 10,520 11,720 12,920 14,120 15,090 15,290

$150,000 - 239,999

2,040 4,440 6,500 7,900 9,230 10,430 11,630 12,830 14,030 15,230 16,190 16,400

$240,000 - 259,999 2,040 4,440 6,500 7,900 9,230 10,430 11,630 12,830 14,030 15,270 17,040 18,040

$260,000 - 279,999

2,040 4,440 6,500 7,900 9,230 10,430 11,630 12,870 14,870 16,870 18,640 19,640

$280,000 - 299,999

2,040 4,440 6,500 7,900 9,230 10,470 12,470 14,470 16,470 18,470 20,240 21,240

$300,000 - 319,999 2,040 4,440 6,500 7,940 10,070 12,070 14,070 16,070 18,070 20,070 21,840 22,840

$320,000 - 364,999

2,720 5,920 8,780 10,980 13,110 15,110 17,110 19,110 21,190 23,490 25,560 26,860

$365,000 - 524,999

2,970 6,470 9,630 12,130 14,560 16,860 19,160 21,460 23,760 26,060 28,130 29,430

$525,000 and over

3,140 6,840 10,200 12,900 15,530 18,030 20,530 23,030 25,530 28,030 30,300 31,800

Single or Married Filing Separately

Higher Paying Job

Annual Taxable

Wage & Salary

Lower Paying Job Annual Taxable Wage & Salary

$0 -

9,999

$10,000 -

19,999

$20,000 -

29,999

$30,000 -

39,999

$40,000 -

49,999

$50,000 -

59,999

$60,000 -

69,999

$70,000 -

79,999

$80,000 -

89,999

$90,000 -

99,999

$100,000 -

109,999

$110,000 -

120,000

$0 - 9,999 $440 $940 $1,020 $1,020 $1,410 $1,870 $1,870 $1,870 $1,870 $2,030 $2,040 $2,040

$10,000 - 19,999

940 1,540 1,620 2,020 3,020 3,470 3,470 3,470 3,640 3,840 3,840 3,840

$20,000 - 29,999 1,020 1,620 2,100 3,100 4,100 4,550 4,550 4,720 4,920 5,120 5,120 5,120

$30,000 - 39,999

1,020 2,020 3,100 4,100 5,100 5,550 5,720 5,920 6,120 6,320 6,320 6,320

$40,000 - 59,999

1,870 3,470 4,550 5,550 6,690 7,340 7,540 7,740 7,940 8,140 8,150 8,150

$60,000 - 79,999 1,870 3,470 4,690 5,890 7,090 7,740 7,940 8,140 8,340 8,540 9,190 9,990

$80,000 - 99,999

2,000 3,810 5,090 6,290 7,490 8,140 8,340 8,540 9,390 10,390 11,190 11,990

$100,000 - 124,999

2,040 3,840 5,120 6,320 7,520 8,360 9,360 10,360 11,360 12,360 13,410 14,510

$125,000 - 149,999 2,040 3,840 5,120 6,910 8,910 10,360 11,360 12,450 13,750 15,050 16,160 17,260

$150,000 - 174,999

2,220 4,830 6,910 8,910 10,910 12,600 13,900 15,200 16,500 17,800 18,910 20,010

$175,000 - 199,999

2,720 5,320 7,490 9,790 12,090 13,850 15,150 16,450 17,750 19,050 20,150 21,250

$200,000 - 249,999 2,970 5,880 8,260 10,560 12,860 14,620 15,920 17,220 18,520 19,820 20,930 22,030

$250,000 - 399,999

2,970 5,880 8,260 10,560 12,860 14,620 15,920 17,220 18,520 19,820 20,930 22,030

$400,000 - 449,999

2,970 5,880 8,260 10,560 12,860 14,620 15,920 17,220 18,520 19,910 21,220 22,520

$450,000 and over

3,140 6,250 8,830 11,330 13,830 15,790 17,290 18,790 20,290 21,790 23,100 24,400

Head of Household

Higher Paying Job

Annual Taxable

Wage & Salary

Lower Paying Job Annual Taxable Wage & Salary

$0 -

9,999

$10,000 -

19,999

$20,000 -

29,999

$30,000 -

39,999

$40,000 -

49,999

$50,000 -

59,999

$60,000 -

69,999

$70,000 -

79,999

$80,000 -

89,999

$90,000 -

99,999

$100,000 -

109,999

$110,000 -

120,000

$0 - 9,999 $0 $820 $930 $1,020 $1,020 $1,020 $1,420 $1,870 $1,870 $1,910 $2,040 $2,040

$10,000 - 19,999

820 1,900 2,130 2,220 2,220 2,620 3,620 4,070 4,110 4,310 4,440 4,440

$20,000 - 29,999 930 2,130 2,360 2,450 2,850 3,850 4,850 5,340 5,540 5,740 5,870 5,870

$30,000 - 39,999

1,020 2,220 2,450 2,940 3,940 4,940 5,980 6,630 6,830 7,030 7,160 7,160

$40,000 - 59,999

1,020 2,470 3,700 4,790 5,800 7,000 8,200 8,850 9,050 9,250 9,380 9,380

$60,000 - 79,999 1,870 4,070 5,310 6,600 7,800 9,000 10,200 10,850 11,050 11,250 11,520 12,320

$80,000 - 99,999

1,880 4,280 5,710 7,000 8,200 9,400 10,600 11,250 11,590 12,590 13,520 14,320

$100,000 - 124,999

2,040 4,440 5,870 7,160 8,360 9,560 11,240 12,690 13,690 14,690 15,670 16,770

$125,000 - 149,999 2,040 4,440 5,870 7,240 9,240 11,240 13,240 14,690 15,890 17,190 18,420 19,520

$150,000 - 174,999

2,040 4,920 7,150 9,240 11,240 13,290 15,590 17,340 18,640 19,940 21,170 22,270

$175,000 - 199,999

2,720 5,920 8,150 10,440 12,740 15,040 17,340 19,090 20,390 21,690 22,920 24,020

$200,000 - 249,999 2,970 6,470 9,000 11,390 13,690 15,990 18,290 20,040 21,340 22,640 23,880 24,980

$250,000 - 349,999

2,970 6,470 9,000 11,390 13,690 15,990 18,290 20,040 21,340 22,640 23,880 24,980

$350,000 - 449,999

2,970 6,470 9,000 11,390 13,690 15,990 18,290 20,040 21,340 22,640 23,900 25,200

$450,000 and over 3,140 6,840 9,570 12,160 14,660 17,160 19,660 21,610 23,110 24,610 26,050 27,350

Residency Certification Form Instructions

 These instructions contain information you will need to complete both the Employee and

Employment Location sections.

 Questions may be directed to the Payroll Department, 412.237.3085.

Employee Information - Residence Location Section

 Enter your Name, street address (no PO boxes), city, state, zip, phone, municipality (city,

borough, or township), and county.

 Then lookup and enter the PSD Code for your municipality on the Municipal Statistics website

(http://munstats.pa.gov/Public/FindLocalTax.aspx) and if necessary the AmericanFactfinder

website (https://factfinder.census.gov/ and select “street address” link in section headed by

“Address Search”).

Employer Information - Employment Location Section

 Enter one of the Employment Location's address, associated PSD Code and rate.

If none of the locations on the next page apply, then use the location from where you are dispatched

or from where you receive your supervision or direction. (For instance, an employee of CCAC who

teaches a paramedic course at the Chippewa Twp. VFD would indicate a work location of West Hills

Center, 1000 McKee Road, Oakdale, PA 15071, because they are dispatched from the Public Safety

Office located at that CCAC facility.)

If you work at more than one CCAC location choose the one from those listed at which you perform

the majority of your service.

Employment Locations

Allegheny Campus

808 Ridge Avenue

Pittsburgh, PA 15212

Office of College Services

800 Allegheny Avenue

Pittsburgh, PA 15233

Pittsburgh Non-resident rate = 1%

PSD Code= 700102

Homewood-Brushton Center

701 N. Homewood Avenue

Pittsburgh, PA 15208

Pittsburgh Non-resident rate = 1%

PSD Code= 700102

Boyce Campus

595 Beatty Road

Monroeville, PA 15146

Monroeville Non-resident rate = 0%

PSD Code= 720301

Braddock Hills Center

250 Yost Blvd.

Pittsburgh, PA 15221

Braddock Hills Non-resident rate = 0%

PSD Code= 721002

North Campus

8701 Perry Highway

Pittsburgh, PA 15237

McCandless Non-resident rate= 0%

PSD Code= 710704

West Hills Center

1000 McKee Road

Oakdale, PA 15071

North Fayette Non-resident rate = 1%

PSD Code= 731802

South Campus

1750 Clairton Road

West Mifflin, PA 15122

West Mifflin Non-resident rate = 1%

PSD Code= 732001

Washington County Center

1500 West Chestnut Street

Washington, PA 15301

North Franklin Non-resident rate = 0%

PSD Code= 631303

Certification Section

Sign and date the form, include the phone and email where you can be contacted if we have

questions regarding the information you supplied on the form.

LOCAL EARNED INCOME TAX

RESIDENCY CERTIFICATION FORM

DCED-CLGS-06 (1-11)

COMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT

GOVERNOR’S CENTER FOR LOCAL GOVERMENT SERVICES

EMPLOYEE INFORMATION - RESIDENCE LOCATION

TO EMPLOYERS/TAXPAYERS:

This form is to be used by employers and/or taxpayers to report essential information for the collection and distribution of Local Earned Income Taxes.

This form must be utilized by employers when a new employee is hired or when a current employee notifies employer of a name and/or address change.

NAME (Last, FIrst, Middle Initial) SOCIAL SECURITY NUMBER

FIRST LINE OF ADDRESS (If PO Box, please include actual street address)

SECOND LINE OF ADDRESS

CITY STATE ZIP CODE DAYTIME PHONE NUMBER

CERTIFICATION

SIGNATURE OF EMPLOYEE DATE

PHONE NUMBER EMAIL ADDRESS

MUNICIPALITY (City, Borough, Township)

COUNTY PSD CODE TOTAL RESIDENT EIT RATE

EMPLOYER INFORMATION - EMPLOYMENT LOCATION

EMPLOYER NAME (Use Federal ID Name) EMPLOYER FEIN

FIRST LINE OF ADDRESS (

If PO Box, please include actual street address)

SECOND LINE OF ADDRESS

CITY STATE ZIP CODE PHONE NUMBER

MUNICIPALITY (City, Borough, Township)

COUNTY PSD CODE MUNICIPAL NON-RESIDENT EIT RATE

For information on obtaining the appropriate MUNICIPALITY (City, Borough, Township), PSD CODES and EIT (Earned Income Tax) RATES,

please refer to the Pennsylvania Department of Community & Economic Development website:

www.newPA.com

Select Get Local Gov Support, >Municipal Statistics

Community College of Allegheny County

25-6075057

LST Exemption 10-07

LOCAL SERVICES TAX – EXEMPTION CERTIFICATE

___________________________________________

Tax Year

APPLICATION FOR EXEMPTION FROM LOCAL SERVICES TAX

¾ A copy of this application for exem

ption from the Local Services Tax (LST), and all necessary supporting documents,

must be completed and presented to your employer AND to the political subdivision levying the Local Services Tax

where you are principally employed.

¾ This application for exem

ption from the Local Services Tax must be signed and da

ted.

¾ No exemption will be approved until proper documentation has been received.

Name: _____

________________________________ Soc Sec #: ____________________________________

Address: ___________________________________ Phone #: _____________________________________

City/State: _________________________________ Zip: _________________________________________

REASON FOR EXEMPTION

1. __________

MULTIPLE EMPLOYERS: Attach a copy of a current pay statement from your principal

employer that shows the name of the employer, the length of the payroll period and the amount of

Local Services Tax withheld. List all employers on the reverse side of this form. You must notify

your other employers of a change in principal place of employment within two weeks of the

change.

2. __________ EXPECTED TOTAL EARNED INCOME AND NET PROFITS FROM ALL SOURCES

WITHIN _____________________________________________ (municipality or school

district) WILL BE LESS THAN $___________: Attach copies of your last pay statements or

your W-2 for the year prior.

If you are self-employed, please attach a copy of your PA Schedule C, F, or RK-1 for the prior

year.

3. __________ ACTIVE DUTY MILITARY EXEMPTION: Please attach a copy of your orders directing you to

active duty status. Annual training is not eligible for exemption. You are required to advise the

tax office when you are discharged from active duty status.

4. __________ MILITARY DISABILITY EXEMPTION: Please attach copy of your discharge orders and a

statement from the United States Veterans Administrator documenting your disability. Only

100% permanent disabilities are recognized for this exemption.

EMPLOYER: Once you receive this Exemption Certificate, you shall not withhold the Local Services Tax for the

portion of the calendar year for which this certificate applies, unless you are otherwise notified or instructed by the

tax collector to withhold the tax.

Tax Office: _________________________________

Address: ___________________________________ Phone #: _____________________________________

City/State: _________________________________ Zip: _________________________________________

IMPORTANT NOTE TO EMPLOYERS

1. The municipality is required by law to exempt from the LST employees whose earned income from all sources (employers

and self-employment) in their municipality is less than $12,000 when the levied rate exceeds $10.00.

2. The school district for the municipality in which your worksite(s) is located may or may not levy an LST. If it does, the

income exemption provided may differ

from the municipality and can be anywhere from $0 to $11,999.

3. Contact the tax office where your business worksites are located to obtain this information.

LST Exemption 10-07

Employment Information: List all places of employment for the applicable tax year. Please list your

PRIMARY EMPLOYER under #1 below and your secondary employers under the other columns. If self

employed, write SELF under Employer Name column.

1. PRIMARY EMPLOYER 2. 3.

Employer Name

Address

Address 2

City, State Zip

Municipality

Phone

Start Date

End Date

Status (FT or PT)

Gross Earnings

4. 5.

Employer Name

Address

Address 2

City, State Zip

Municipality

Phone

Start Date

End Date

Status (FT or PT)

Gross Earnings

PLEASE NOTE:

All information received by the Ta

x Collector is considered to be CONFIDENTIAL and is only used for

official purposes relating to the collection, administration and enforcement of the LOCAL SERVICES

TAX.

I DECLARE UNDER PENALTY OF LAW THAT THE INFORMATION STATED ON AND

ATTACHED TO THIS FORM IS TRUE AND CORRECT:

SIGNATURE: _________________________________________________ DATE: ____________________

COMMUNITY COLLEGE OF ALLEGHENY COUNTY

DIRECT DEPOSIT

AUTHORIZATION AGREEMENT

Name [Print______]_______________________________________________CCAC ID NUMBER______________________

I have attached a voided check or other document which can be used to identify my financial institution and account number where

I want my payroll deposited to my:

CHECKING SAVINGS (check one)

It is my understanding that if CCAC makes an overpayment deposit, CCAC may make a debit directly from my account in the amount

of the overpayment to recover the funds. To prevent any delay in deposits, I will immediately notify the payroll department when I

close my account, change banks or account numbers.

I have read, understand this agreement, and have attached to appropriate document.

Signature: __________________________________________________________Date:____________________

ATTACH VOIDED OR CANCELLED CHECK OR SAVINGS ACCOUNT DEPOSIT SLIP

AND RETURN WITH THIS FORM TO THE PAYROLL

DEPARTMENT OR CAMPUS BUSINESS OFFICE.

CCAC – PAYROLL DEPARTMENT

800 ALLEGHENY AVENUE

PITTSBURGH, PA 15233-1804

PAY ADVICE ONLINE

I understand that by establishing a direct deposit CCAC will deliver my earnings statement on MyCCAC (if applicable

) and I will be

able to take advantage of the following benefits offered through this technology:

 Early Access to current pay information

 Current and historical pay information

 Easy and safe retrieval from any computer

 No lost or undeliverable pay advices

If a voided check or savings account deposit slip

is not supplied by your financial institution you may supply documentation of your

account in person with proof of identity to the Payroll Department or campus Business Office. Documentation should include

your current name, address, account number and the financial institution transit routing number.

If you do not have a network account you will receive a paper deposit advice in the US mail.

Employee Manual – Approved April 7, 2005

5.3. SEXUAL HARASSMENT

5.3.1 Definition

The College has a strict policy prohibiting all forms of sexual harassment at the work place. This

policy applies to all employees, supervisors, students, vendors and non-employees who have

contact with our employees and students. Sexual harassment includes, but is not limited to,

unwelcome sexual advances, requests to an employee for sexual favors, and other visual, verbal,

or physical conduct of a sexual or offensive nature when either:

a. Submission to such conduct is made an explicit or implicit term or condition of

employment, continued employment, or advancement;

b. Submission to or rejection of such conduct by an individual is used as the basis for

employment decisions affecting the individual; or

c. Such conduct has the purpose or effect of interfering with an individual’s work

performance or creating an intimidating, hostile, or offensive working environment.

5.3.2 Reporting Misconduct

Any employee who feels s/he or other coworker(s) is a victim of sexual harassment should

immediately report any misconduct to any of the following: their immediate supervisor,

Kimberly Manigault in Human Resources, or Sumana Misra-Zets, Civil Rights Compliance

Officer, without fear of reprisal. The employee can bypass anyone involved in the harassment in

reporting it. All complaints and related information will be thoroughly investigated and kept

confidential to the fullest extent possible in order to complete a thorough investigation. The

results of the investigation shall be promptly reported to the person(s) making the complaint(s).

5.3.3 Outcomes

Employees who, after investigation, have been determined to have been engaging in the sexual

harassment of their co-workers or students or the use of profane or abusive language which

violates the sensitivities of their co-workers or students will be subject to disciplinary action, up

to and including termination.

5.3.4 Required Signature

A one-page summary of this sexual harassment policy will be included with new employee’s

copy of these regulations. All CCAC employees are required to sign the summary as proof that

they have read and understand CCAC’s sexual harassment policy. This form is to be returned to

the Human Resources Department and signed by a CCAC representative. The original will be

kept in the employee’s personnel file.

5.3.5 Student Complaint

Students who believe they have been sexually or unlawfully harassed and wish further

information or assistance in filing a complaint should contact the College’s Civil Rights

Compliance Officer, Sumana Misra-Zets, 808 Ridge Avenue, Pittsburgh, PA 15212, (412) 237-

4535.

**This regulation is also available on the Human Resources website: https://www.ccac.edu/EmployeeManual/

SEXUAL HARASSMENT REGULATION

ACKNOWLEDGMENT

I acknowledge that I have received, read and understand the Sexual Harassment

Regulation of the Community College of Allegheny County (CCAC) effective April 7, 2005. I

represent and agree that I will abide by CCAC’s Sexual Harassment Regulation, which includes

the sexual harassment regulation contained in CCAC’s Student Handbook.

I further understand and agree that this Acknowledgment will be placed in my personnel

file and will become a permanent part thereof.

___________________________________

Employee (Print name clearly)

___________________________________ ___________________________________

Employee (Signature) Date

___________________________________

CCAC Representative (Print name clearly)

___________________________________ ___________________________________

CCAC Representative (Signature as witness) Date

**Please return signed document to the Human Resources department Thank you!

COMMUNITY COLLEGE OF

ALLEGHENY COUNTY

COLLEAGUE- NETWORK ACCESS

Confidentiality Acknowledgment

I understand that student, employee, and financial information from any source and in any form is

confidential and is available to me solely for the performance of my official duties as a Community

College of Allegheny County (CCAC) employee. I will protect the privacy and confidentiality of

student, employee, and financial information to which I have access and will use it solely for the

performance of my official duties, while on or off site. I also understand that through Colleague-

Network access, I may have the ability to access information outside my unit of responsibility, but will

only utilize that access as it applies to my unit of responsibility.

I FURTHER AGREE THAT:

1. I WILL only access information I need to do my job.

2. I WILL protect the privacy of student, employee, and financial information.

3. I WILL keep my Colleague and Network password secret and I will not share it with

anyone.

4. I WILL log off any password-protected application before leaving my workstation.

5. I WILL tell my supervisor if I think someone knows or is using my Colleague or Network

password.

6. I WILL NOT show, tell, copy, give, sell, review, change, trash or otherwise utilize any

confidential information except as it relates to my job. If it is part of my job to do any of these

tasks, I will follow the correct department procedure (such as shredding confidential papers

before throwing them away).

7. I WILL NOT misuse or be careless with confidential or sensitive information.

8. I WILL NOT use anyone else’s password to access Colleague or Network access.

9. I WILL NOT share any confidential or sensitive information even if I am no longer a CCAC

employee.

10. I AM RESPONSIBLE for any access using my Colleague or Network password.

11. I AM RESPONSIBLE for my use of confidential information.

12. I AM RESPONSIBLE for my failure to protect my Colleague and Network password or

access to confidential information.

13. I KNOW that my access to confidential information may be audited.

14. I KNOW that confidential information I learn on the job does not belong to me.

15. I KNOW that CCAC may take away my access to Colleague or the CCAC Network at any

time.

Failure to comply with this acknowledgment may result in disciplinary action regarding my

employment, up to and including termination from CCAC and/or civil or criminal legal penalties. By

signing this, I agree that I have read and understand the acknowledgment.

Signature: __________________________________________ Date: ______________

Print Full Name (legibly): _____________________________________________

Department: ______________________________ Campus:______________________

Centers: _________________________________

Supervisor _______________________________

      

         

       

               

                    

               

          

         

       

                

                     

  



                

       

•                

                



•             

             



•                

               

 

•               

  

•                 

 

•                

    

•               

         

    

•                

•                

                

              



           

        

       

 

    

         

            

      

WORKERS’ COMPENSATION INFORMATION

To all employees:

The workers’ compensation law in Pennsylvania provides wage loss and medical benefits to

employees who cannot work, or who need medical care, because of a work-related injury.

Benefits are required to be paid by your employer when self-insured, or through insurance

provided by your employer. Your employer is required to post the name of the company

responsible for paying workers compensation benefits at its primary place of business and at its

sites of employment in a prominent and easily accessible place, including, without limitation,

areas used for treatment of injured employees or for the administration of first aid.

You should report immediately any injury or work-related illness to your employer.

Your benefits could be delayed or denied if you do not notify your employer immediately.

If your claim is denied by your employer, you have the right to request a hearing before a

workers’ compensation judge.

The Bureau of Workers’ Compensation cannot provide legal advice. However, you may contact

the Bureau of Workers’ Compensation for additional general information at:

Bureau of Workers’ Compensation

1171 South Cameron Street, Room 103

Harrisburg, PA 17104-2501

Telephone number within Pennsylvania: 800-482-2383

Telephone number outside of this Commonwealth: 717-772-4417

TTY- 800-362-4228 (for hearing and speech impaired only)

www.state.pa.us PA Keyword: workers comp.

NEW EMPLOYEES

I, _____________________________, employee of _______________________ (employer),

certify that I received, read, and understood the information provided above on my date of hire

______________ (date.)

CURRENT EMPLOYEES

If applicable, I, ____________________________, employee of __________________________

(employer), certify that I received, read, and understood the above information on

_______________ (the date of work-related injury or disease).

New

Health Insurance Marketplace Coverage

Options

and Your

Health Coverage

PART A: General

Information

When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance

the Health

Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic

information about the new Marketplace and employmentbased health coverage offered by your employer.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The

Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible

for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance

coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or

offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on

your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for

a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be

eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does

not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your

employer that would cover you (and not any other members of your family) is more than 9.5% of your household income

for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the

Affordable Care Act, you may be eligible for a tax credit.

Note:

If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your

employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer

contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for

Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax

basis.

How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description or

contact Michael Swartzendruber - mswartzendruber@ccac.edu

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the

Marketplace and its cost. Please visit

HealthCare.gov

for more information, including an online application for health

insurance coverage and contact information for a Health Insurance Marketplace in your area.

employer-sponsored health plan meets the "minimum value standard"

if the

plan's

share of

the total allowed benefit costs covered

the plan

is no less

than 60 percent

such costs.

Form Approved

OMB No. 1210-0149

(expires 6-30-2023)

PART B: Information About Health Coverage Offered by Your Employer

This section contains information about any health coverage offered by your employer. If you decide to complete an

application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to

correspond to the Marketplace application.

Employer name

Employer Identification Number (EIN)

Employer address

Employer phone number

City

State

9. ZIP

code

10.

Who can we contact about employee health coverage at this job?

11. Phone number (if different from above) 12. Email address

Here is some basic information about health coverage offered by this employer:

•

As your employer, we offer a health plan to:

All employees. Eligible employees are:

Some employees. Eligible employees are:

•

With respect to dependents:

We do offer coverage. Eligible dependents are:

We do not offer coverage.

If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be

affordable, based on employee wages.

** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount

through the Marketplace. The Marketplace will use your household income, along with other factors, to

determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to

week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed

mid-year, or if you have other income losses, you may still qualify for a premium discount.

If you decide to shop for coverage in the Marketplace,

HealthCare.gov

will guide you through the process. Here's the

employer information you'll enter when you visit

HealthCare.gov

to find out if you can get a tax credit to lower your

monthly premiums.

25-6075057

Community College of Allegheny County

800 Allegheny Avenue

Pittsburgh

15233

412-323-2323

Michael Swartzendruber, Director of Compensation, Benefits, and HRIS

mswartzendruber@ccac.edu

412-237-3038

All regular positions, grant-funded positions funded with benefits, or temporary positions designated

as full-time. Other temporary employees in administrative, support staff, advising, tutoring, or adjunct

faculty at full employee cost.

Legal spouse, dependent children under 26 years of age, and/or dependent child who is disabled.

Community College of Allegheny County Tax Deferred Annuity 403 (b) - Elective Deferrals

UNIVERSAL AVAILABILITY NOTICE

Community College of Allegheny County, (“CCAC”) provides you with the opportunity to save for your retirement

through the CCAC Retirement Plan (“Plan”). Your employer would like you to know more about how you can participate

in the Plan. Whether you want to enroll in the Plan, or you are already enrolled but wish to change the amount of your

deferral, you can accomplish your goal by filling out a “Salary Reduction Agreement for 403(b) Elective Deferral.” You

can obtain a copy of the agreement and information on the Plan from the Community College of Allegheny County

myCCAC portal or by contacting the Human Resources Office at Office of College Services by calling 412-237-3001.

Eligibility

If you are an employee of CCAC and are not a student regularly attending classes offered by CCAC, then you are eligible

to participate in the Plan, as long as a minimum of $200 is contributed per year. Eligible employees may participate in

the Plan effective as of their date of hire.

Please take a moment to review the plan brochure or website before enrolling. Once you are enrolled, you can review

and change the amount of your contributions and your investment allocations at any time. The exact date your

investment allocations will take effect may vary depending upon the policies of the financial service firm providing the

investment options you chose for plan contributions.

Also, please be aware that the law limits the amount you may defer under this and other plans in any tax year. For 2021,

the limit under all plans of this type is generally $19,500 although larger limits may apply if you are age 50 or over or you

have at least 15 years of service with CCAC. Each participant only gets one limit for contributions to all 403(b) plans, so if

you are also a participant in a 403(b) plan of another employer, your combined contributions to that plan and to the

CCAC’s Retirement Plan in 2020 are generally limited to $19,500. If you do participate in more than one 403(b) plan, you

are responsible for tracking and reporting the amount of all of your contributions to the plans so that the total amount

of all your contributions to all plans in which you participate does not exceed the limit. Note also that the sum of all of

your contributions, and those of your employers, to all 403(b) plans that you participate in are generally limited to the

lesser of $58,000 or 100% of your compensation in 2021.

For further details, or if you have questions, please contact your Human Resources Office at 412-237-3001.

Employee may detach from packet and keep for reference

How to Provide Emergency Information

Description of documentation:

The following procedures include details of viewing and confirming your emergency information within CCAC

Central Self-Service. Your information will be kept confidential and only used if needed in an urgent or

emergency situation. By completing/editing this information, the employee is authorizing CCAC to utilize this

information in emergency situations. In addition to the HR office, the Deans of Administration and the Directors

of Safety and Security will have view access to the information you provide.

Instructions

Accessing Portal:

 Navigate to https://my.ccac.edu

 Enter your Network Identification (Net ID)

 Click Sign in

Navigating to Self-Service

1. Select “Employees” from CCAC Central

Self-Service menu

2. Select “User Account”

3. Select “Self Service Emergency Info”

Adding a new emergency contact:

 Click the button for “Add New Contact”

 Enter in the required name and phone details

 Select a contact type; either Emergency or Missing Person

 Click “Add Contact button”

 You can add other emergency information, such has hospital preference, insurance information, and

additional information as needed.

 Click Confirm.

More detailed instructions are available if needed by navigating and logging into MyCCAC technology page

(https://my.ccac.edu/facultyresources/ccactechnology/Pages/ccaccentralselfservice.aspx). In the documents

section, select the link “CCAC Central Self-Service – Employee Emergency Information”.

Employee may detach from packet and keep for reference

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