Employee Specific Forms

WinCap Change Requests

Form Name	Forms
WinCap Desktop Change/Access Request	Click to Access
WinCapWeb (Timesheets) Change/Access Request	Click to Access

Payroll Information

Form Name	Forms
Wincap Employee Self Service	Click to Access
Payroll Schedule 2024-2025	Download
Payroll Schedule 2024-2025** with pay period dates	Download
Direct Deposit Form	Download

Flexible Spending

Flex Spending Reimbursement Forms: Late Filing Deadline for 2023 is 4/1/2024

Form Name	Forms
2024 Flexible Spending Letter	Download
2024 Flexible Spending Enrollment Form	Download
2024 Flexible Spending FBA Info Packet	Download
Healthcare Reimbursement Form	Download
Dependent Care Reimbursement Form	Download

For a listing of eligible expenses, click here

Health Insurance

Form Name	Forms
Required Exchange Marketplace Notification to Employees Covering Young Adult Children Under the Patient Protection and Affordable Care Act (PPACA), your young adult children can be covered on your health insurance plan up to age 26.	Download
Download Health Insurance Buyout form Among the provisions of the collective bargaining agreements (CBA) between the District and certain units is the right of a staff member eligible for health insurance to receive a buyout for such coverage if they elect not to take the coverage. In essence, a staff member may drop his/her medical coverage and be reimbursed a portion of the premium saved from the District’s contribution. Please refer to the “Health Insurance” section of your CBA for the specific language related to this provision.	Download

Form Name

Forms

Required Exchange Marketplace Notification to Employees

Covering Young Adult Children Under the Patient Protection and Affordable Care Act (PPACA), your young adult children can be covered on your health insurance plan up to age 26.

Download Health Insurance Buyout form

Among the provisions of the collective bargaining agreements (CBA) between the District and certain units is the right of a staff member eligible for health insurance to receive a buyout for such coverage if they elect not to take the coverage. In essence, a staff member may drop his/her medical coverage and be reimbursed a portion of the premium saved from the District’s contribution. Please refer to the “Health Insurance” section of your CBA for the specific language related to this provision.

403(b) and 457 Plans

You have the opportunity to save for retirement by participating in the following Plainview-Old Bethpage

Central School District’s Retirement Plans, please click here for the latest information about annual limits.

Form Name	Forms
2025 Maximum Allowable Contribution (MAC) Limits	Download
2024 Maximum Allowable Contribution (MAC) Limits	Download
Salary Reduction Agreement (Download PDF Version)	Download
Online Salary Reduction Agreement (SRA) (Fillable online version)	Download
403(b) Link to OMNI Website: -contact: 1-877-544-6664 -Salary Reduction Agreement -Hardship Requests Form -Loan Requests Form -Participating Service Providers	www.omni403b.com
US OMNI & TSACG Plan Sponsor Newsletter	Spring 2025 Newsletter
403(b) Why Me? Educational Video Link to the Benefits of Starting a 403 (b) on YouTube	http://youtu.be/Oi9bOeZfgMc
457 Link to NYS Deferred Compensation Plan -contact: 1-800-422-8463 -General Plan Information -Enrollment Form	www.nysdcp.com

Mileage

Form Name	Forms
NEW 2025 Mileage Reimbursement Form 2024 Mileage Reimbursement Form	Download Download

Form Name

Forms

Other Forms

Form Name	Forms
Employee Accident Form	Download
Student Injury Report	Download

Plainview-Old Bethpage Central School District