Get Your Free Eligibility Report
What Information Is Needed?
We Need Your Employee Payroll Census For The Supplemental Healthcare Eligibility Report.
Please provide the following information for each W-2 Employee in your company.
First/Last Name (or Employee 1, Employee 2...)
Hourly or Salaried
Average Hours Worked per pay period
Hourly Rate or Salary
Federal Status - Single or Married
Fed Allowance
Additional Withholdings
State Status - Single or Married
State Allowance
Additional Withholdings
Work State
Health & Medical Deductions
Remaining Pre-Tax Withholdings (Total All)
Pre-Tax Retirement Contributions
Post-Tax Deductions (Total All)
Post-Tax Retirement Contributions
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