Authorization for General Date       Entered__________________

              Payroll Deductions                                                  Entered By_______________

Employee Name_________________________________________________________________________

Employee ID                  Department/Division__________________________________             

5- digit   PeopleSoft ID (NOT SS# or Badge #)

Deduction

Code

Amount

Deduction

Start

Date

Deduction

End

Date

  AFSCME                        SEND COMPLETED FORM TO EMPLOYEE BENEFITS

  AFSCME Union Dues

  AFSCME*

Defaults to table

  AFSCME Insurance

  AFINS**

  FOP                               SEND COMPLETED FORM TO EMPLOYEE BENEFITS

  FOP Union Dues

  FOP123*

Defaults to table

  FOP Insurance

  FOPINS**

  FOP Political Action Committee

  FOPPAC**

  Police Department Association

  PDASN**

  Police Department Benefit Assoc

  POLBN*

Defaults to table

  Police Department Insurance

  PDINS**

  IAFF                              SEND COMPLETED FORM TO EMPLOYEE BENEFITS

  IAFF Union Dues

  IAFF*

Defaults to table

  5th Quarter Civic Association

  5QTR*

Defaults to table

  Fire Benefit Fund

  FIRBEN*

Defaults to table

  Fire Cash Benevolence #1

  FCB*

Defaults to table

  Fire Cash Benevolence #2

  FCB2*

Defaults to table

  Fire Mutual Aid Fund

  FIRMUT*

Defaults to table

  IAFF Insurance

  IAFINS**

  IAFF Political Action Committee

  IAFPAC**

  Miscellaneous               SEND COMPLETED FORM TO EMPLOYEE BENEFITS

  Mun EE Charitable Contribution

  MECCC**

  Mun Employee Credit Union

  MECU**

  OKC Employee Association

  EEASSN*

Defaults to table

  Pre-Paid Legal

  PPLEGL*

Defaults to table

  US Savings Bonds

  USBOND**

Separate form required to start deduction

  457 Deferred Compensation Plans       SEND COMPLETED FORM TO OCERS (Retirement)

  ICMA 457 - Standard

  ICMA1

  ICMA 457 - Catch Up

  ICMA2

  ICMA 457 - Over Age 50

  ICMA3

  Nationwide 457 - Standard

  NRS1

  Nationwide 457 - Catch Up

  NRS2

  Nationwide 457 - Over Age 50

  NRS3

Employee Signature______________________________________________Date_______________________