VT Sick Time Accrual Form

Client Number

Client Name

Company Number *

Company Name *

Date Requested

Date

Change Effective Date *

Please note: for proper audit, PayData 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 PayData which employees should receive this bank.

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 hour worked
0-999	.0193	40 hours

How does this accrue per pay period?

Which earn code(s) reduce bank balance?

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.

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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).

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I agree to and authorize PayData to make the above changes to our company set up.

Authorized Client Representative *

Title *

Signature *

VT Sick Time Accrual Form

For Hourly Employees:

For Salary Employees: