Deduction Change Form

PAYROLL DEDUCTION AUTHORIZATION FORM
This DOES NOT apply to Federal or State Taxes
Date of Change Requested*

MonthDayYear
Must be at least the Monday prior to paycheck you want the change made.
Name*
Email
example@example.com
Name of First Deduction*
i.e. HSA, North American, American Funds etc
Total Requested Amount PER CHECK*
Name of Second Deduction
Total Requested Amount PER CHECK
I hereby authorize my employer to make the above change to my deduction. I understand that I am responsible to submit a new form if further changes are needed.

This form must be submitted no later than the Monday prior to pay day.
Signature*
*The Pay Calendar can be found on the SUSD Website under Resources - Human Resources - Payroll Documents.
Should be Empty: