Important Contacts Treasurer s Office Judy Entinger Lora Hunt Rick Knapp Human Resources Vicki Baptist Nichole Walters

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2 Important Contacts Treasurer s Office Judy Entinger Payroll (Classified and Supplemental Staff) Judy_Entinger@plsd.us / Lora Hunt Payroll (Certified Staff and Substitute Teachers) Lora_Hunt@plsd.us / Rick Knapp Payroll and Benefits Coordinator Rick_Knapp@plsd.us / Human Resources Vicki Baptist Administrative Secretary Human Resources Department Vicki_Baptist@plsd.us / Nichole Walters Administrative Secretary Human Resources Department Nichole_Walters@plsd.us /

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6 IT 4 Rev. 5/07 Notice to Employee 1. For state purposes, an individual may claim only natural dependency exemptions. This includes the taxpayer, spouse and each dependent. Dependents are the same as defined in the Internal Revenue Code and as claimed in the taxpayer s federal income tax return for the taxable year for which the taxpayer would have been permitted to claim had the taxpayer filed such a return. 2. You may file a new certificate at any time if the number of your exemptions increases. You must file a new certificate within 10 days if the number of exemptions previously claimed by you decreases because: (a) Your spouse for whom you have been claiming exemption is divorced or legally separated, or claims her (or his) own exemption on a separate certificate. (b) The support of a dependent for whom you claimed exemption is taken over by someone else. (c) You find that a dependent for whom you claimed exemption must be dropped for federal purposes. The death of a spouse or a dependent does not affect your withholding until the next year but requires the filing of a new certificate. If possible, file a new certificate by Dec. 1st of the year in which the death occurs. For further information, consult the Ohio Department of Taxation, Personal and School District Income Tax Division, or your employer. 3. If you expect to owe more Ohio income tax than will be withheld, you may claim a smaller number of exemptions; or under an agreement with your employer, you may have an additional amount withheld each pay period. 4. A married couple with both spouses working and filing a joint return will, in many cases, be required to file an individual estimated income tax form IT 1040ES even though Ohio income tax is being withheld from their wages. This result may occur because the tax on their combined income will be greater than the sum of the taxes withheld from the husband s wages and the wife s wages. This requirement to file an individual estimated income tax form IT 1040ES may also apply to an individual who has two jobs, both of which are subject to withholding. In lieu of filing the individual estimated income tax form IT 1040ES, the individual may provide for additional withholding with his employer by using line 5. please detach here hio Department of Taxation Employee s Withholding Exemption Certificate IT 4 Rev. 5/07 Print full name Social Security number Home address and ZIP code Public school district of residence (See The Finder at tax.ohio.gov.) School district no. 1. Personal exemption for yourself, enter 1 if claimed If married, personal exemption for your spouse if not separately claimed (enter 1 if claimed) Exemptions for dependents Add the exemptions that you have claimed above and enter total Additional withholding per pay period under agreement with employer... $ Under the penalties of perjury, I certify that the number of exemptions claimed on this certificate does not exceed the number to which I am entitled. Signature Date

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8 Statement Concerning Your Employment in a Job Not Covered by Social Security Employee Name Employer Name Employee ID# Employer ID# Your earnings from this job are not covered under Social Security. When you retire, or if you become disabled, you may receive a pension based on earnings from this job. If you do, and you are also entitled to a benefit from Social Security based on either your own work or the work of your husband or wife, or former husband or wife, your pension may affect the amount of the Social Security benefit you receive. Your Medicare benefits, however, will not be affected. Under the Social Security law, there are two ways your Social Security benefit amount may be affected. Windfall Elimination Provision Under the Windfall Elimination Provision, your Social Security retirement or disability benefit is figured using a modified formula when you are also entitled to a pension from a job where you did not pay Social Security tax. As a result, you will receive a lower Social Security benefit than if you were not entitled to a pension from this job. For example, if you are age 62 in 2005, the maximum monthly reduction in your Social Security benefit as a result of this provision is $ This amount is updated annually. This provision reduces, but does not totally eliminate, your Social Security benefit. For additional information, please refer to Social Security Publication, Windfall Elimination Provision. Government Pension Offset Provision Under the Government Pension Offset Provision, any Social Security spouse or widow(er) benefit to which you become entitled will be offset if you also receive a Federal, State or local government pension based on work where you did not pay Social Security tax. The offset reduces the amount of your Social Security spouse or widow(er) benefit by two-thirds of the amount of your pension. For example, if you get a monthly pension of $600 based on earnings that are not covered under Social Security, two-thirds of that amount, $400, is used to offset your Social Security spouse or widow(er) benefit. If you are eligible for a $500 widow(er) benefit, you will receive $100 per month from Social Security ($500 - $400=$100). Even if your pension is high enough to totally offset your spouse or widow(er) Social Security benefit, you are still eligible for Medicare at age 65. For additional information, please refer to Social Security Publication, Government Pension Offset. For More Information Social Security publications and additional information, including information about exceptions to each provision, are available at You may also call toll free , or for the deaf or hard of hearing call the TTY number , or contact your local Social Security office. I certify that I have received Form SSA-1945 that contains information about the possible effects of the Windfall Elimination Provision and the Government Pension Offset Provision on my potential future Social Security benefits. Signature of Employee Date Form SSA-1945 ( )

9 Ohio New Hire Reporting Ohio Revised Code section to requires all Ohio employers, both public and private, to report all contractors and newly hired, rehired, or returning to work employees to the state of Ohio within 20 days of the contract, hire, or rehire date. Information about new hire reporting and online reporting is available on our website: Send completed forms to: Ohio New Hire Reporting Center PO Box Columbus, OH Fax: (614) or toll-free fax (888) To ensure the highest level of accuracy, please print neatly in capital letters and avoid contact with the edges of the boxes. The following will serve as an example: EMPLOYER INFORMATION Federal Employer ID Number (FEIN) (Please use the same FEIN as the listed employee s quarterly wages will be reported under): A B C Employer Name: Employer Address (Please indicate the address where the Income Withholding Orders should be sent). Employer City: Employer State: Zip Code (5 digit): Employer Phone (optional): Extension: Employer Fax (optional): EMPLOYEE OR CONTRACTOR INFORMATION Social Security Number (SSN) (Check here if using FEIN for the Contractor) First Name: State of Hire: Middle Initial: Last Name: Address: City: State: Zip Code (5 digit): Date of Hire: Date of Birth: Is this a Contractor? Yes No Date payments will begin for Contractor: Length of time the Contractor will be performing services: months REPORTS WILL NOT BE PROCESSED IF REQUIRED INFORMATION IS MISSING JFS (Rev. 3/2007) Questions? Call us at (614) or toll-free (888) Ohio Department of Job and Services

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