VT Sick Time Accrual Form

VT Sick Time Accrual Form

Revised 11-19-21
Client Number
Client Name
Company Number*
Company Name*
Date Requested

MonthDayYear
Date
Change Effective Date*

MonthDayYear
Please note: for proper audit, Asure requires advance notice of 5 business days for company changes.
A. Does your company offer paid time off to employees?*
B. Is this available to full time employees and part time employees who work an average of 18 hours or more per week?
If you answered yes to A & B, you may not need to make changes. Please review the link below to ensure compliance.

ACT 69 - VT Mandatory Paid Sick Policy - Effective January 1, 2017:

https://labor.vermont.gov/sites/labor/files/doc_library/Earned-Sick-Time-Rules.pdf
Notes or special instructions
New ED Code
Name of Accrual
Please note: It is the employers' responsibility to tell Asure which employees should receive this bank.
For Hourly Employees:
Should the accrual be on worked hours only (ex.: exclude holiday, jury duty, etc.)
Which earn codes to exclude?
When should the accrual be available for usage?
After how many days of employment should the accrual be available for usage?

Month - Month	Rate	Carryover Max	Maximum Accrual
If per pay period
0-999	.77 (Weekly) 1.54 (Bi-Weekly) 1.67 (Semi-Monthly) 3.34 (Monthly)	40 Hours	40 Hours
If standard hours worked
0-999	.0193	40 Hours	40 Hours

Please attach a list of employees who are currently eligible for this accrual and their beginning balances, or list them below.

Cancelof
Employees who are currently eligible for this accrual and their beginning balances:
Please attach a copy of your accrual documentation as it appears in your employee handbook (if applicable).

Cancelof
I agree to and authorize Asure to make the above changes to our company set up.
Authorized Client Representative*
Title*
Signature*
Should be Empty:

For Hourly Employees: