Lump Sum Add or Rescind Request

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Time Left to Submit Lump Sum Add or Rescind Request
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Lump Sum Payment/Rescind Request

CERTIFIED STAFF ONLY!!

THIS FORM IS DUE BY APRIL 30, 2021

If you would like to request a Lump Sum salary payment for the current school year, please complete form and submit. The lump sum payment will mean that the four semi-monthly payments scheduled for 6/15, 6/31, 7/15 and 7/31 would be made in a single “Lump Sum” payment on June 15th.

If you are NEW to Lump Sum please read this in its entirety, and indicate your choice when prompted.

If you DO NOT wish to receive a Lump Sum salary payment this year, but received it last school year, you MUST request that the Lump Sum be RESCINDED, by indicating your choice when prompted. If you DO NOT wish to receive a lump sum salary payment this year, and did not receive one last year, you do not need to do anything.

THE W4 FORM HAS BEEN RECREATED - PLEASE FAMILIARIZE YOURSELF AND GO BY THE INSTRUCTIONS ATTACHED TO THE W-4 FORM. CONTACT YOUR TAX ADVISOR FOR HELP WITH QUESTIONS. THE STATE FORM HAS NOT CHANGED, SO YOU MAY CHOOSE TO USE EXEMPTIONS THERE.

IN ORDER FOR THE EXEMPTIONS/ADJUSTMENTS THAT YOU ELECT TO TAKE EFFECT ON JUNE 15TH, YOU MUST MAKE YOUR CHANGES IN THE BUSINESS PLUS EMPLOYEE ONLINE SYSTEM BEGINNING MAY 31ST THROUGH JUNE 4TH. ANY CHANGES MADE AFTER JUNE 4TH WILL NOT BE REFLECTED ON YOUR LUMP SUM CHECK. Please contact the TIS helpdesk by email if you are not able to get online at support@kckps.org.

After logging into Employee Online, select the link titled “Tax info” in the blue column on the left side of the page, make any necessary edits, and click “Save”. Please keep in mind the system will only allow you to change your tax information once per pay period.

The Payroll Department cannot be responsible for any changes to your federal or state tax. It is your responsibility to make any and all changes in Employee Online. Please keep in mind, any changes you make will remain in place until you change them again.

THIS FORM IS DUE BY APRIL 30, 2021

This Form Can Be Saved In Progress and Completed at a Later Time.
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Employee Name* This field is required.
First Name
Middle Initial
Last Name
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Employee Identification Number* This field is required.Enter Your 5 Digit Employee Identification Number
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Phone Number* This field is required.If We Have Questions
Enter Your Phone Number
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Work Email* This field is required.
pat.smith@kckps.org
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Building Number or Building Name* This field is required.Enter the Building Number or Building Name of Your Current Duty Station
(Example: 106; or Wyandotte High School)
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What Would You Like to Do?* This field is required.All requests for Lump Sum payments must be made by April 30th of the current school year as required by Kansas statutes. Only those employees who are under a teacher’s contract may request Lump Sum payment.
I Want to Request a Lump Sum Payment.
I Received a Lump Sum Payment Last Year, But Would Like to Rescind This Year.
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Certify with Your SignatureUsing Your Mouse for PC or Mac, or Your Finger or Apple Pencil or Stylus, Sign the Form to Confirm.
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If You Have Requested to Receive a Lump Sum Payment.

Please Read The Following carefully...

1. I acknowledge that I am responsible for making any desired changes to my federal and state income tax exemptions in Business Plus Employee Online system begining 5/31/2021 to 06/04/2021. I understand that changes I make will remain in place until I change them again. I understand that the Business Office cannot give tax advice, and I should consult with a tax professional if I have any questions regarding taxes or exemptions.

The W-4 Federal withholding form does not allow exemptions, please follow the instructions that are attached to the W4.

2. I acknowledge that the following deductions, if applicable, will be deducted at 4 times the standard rate to reflect the 4 pay periods in June and July: Health insurance, dental insurance, vision insurance, optional group life insurance, short-term disability insurance, al critical care insurance, flex spending, health savings accounts, 403 (b) Roth, and 457 (b) Tax Sheltered Annuities.

3. I acknowledge that United Way contributions will be deducted at 2 times the standard rate to reflect the month of June only.

4. I acknowledge that all garnishments or wage attachments, if applicable, must be deducted at the rate required by the court order. In most cases, this will be 4 times the standard rate.

5. I acknowledge that if my pay is being docked, or I have entered into a payment arrangement with the district for any reason, the deduction will be calculated based on the existing agreement with the Human Resources Department. In most cases, this will be 4 times the standard rate.

By signing below, I understand USD500 will make deductions from my June 15, 2021 check in Accordance with the terms indicated above.

The deadline for completing and submitting the form is Friday, April 30,2021

You may also request a fillable PDF version of this form that can be completed, signed and faxed to (913) 551-3264 or email tressie.brown@kckps.org or jenise.hattley@kckps.org.
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Acknowledgement - Lump Sum Payment RequestI Have Read and Understand the Previous Page.
YESNO
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Acknowledgement - Request to Rescind Lump Sum PaymentI Acknowledge That I WILL NOT Receive a Lump Sum Payment This Year.
YESNO
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