East Tennessee State University | Office of Human Resources
East Tennessee State University | Office of Human Resources | Attachment A
Edited: 1/31/2019 Page 1 of 2
East Tennessee State University
Tennessee Board of Regents
Moving Expense Allowance Request Form: Attachment A
Potential Employee’s Name: ____________________________________________________________
E# if available or last 4 digits of Social Security #: _________________________
Potential Employment Date: __________________________________________
Less: Income Tax Withholding (22%)
Less: Medicare Tax (1.45%)
Net Amount to be paid to the potential
employee:
Note: Individuals in special tax situations (non-citizens, graduate students, etc.) may have
more or less tax deducted.
Please note: Moving Expense Allowances are not covered under the University’s accountable expense plan. Therefore, the
allowance will be reported as taxable income to the employee and applicable withholding taxes will be withheld from the
payment. The potential employee’s year-end tax statement (W-2) will include the gross amount of this allowance and all
applicable taxes withheld in the year of the payroll start date. Additionally, the responsible department will be charged the
matching amount of social security and Medicare taxes.
Prepared by: _________________________________________________ Date: ___________________
Chair Approval: ______________________________________________ Date: ___________________
Note: This charge will appear on your ledger as a Moving Expense Allowance when the payroll is posted.
Dean Approval: ______________________________________________ Date: ___________________
Vice President Approval: _______________________________________ Date: ___________________
Potential Employee Acknowledgement: ___________________________ Date: ___________________
