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Commuter Benefits Plan (Parking) Election/Change Form

Commuter Benefit Plan (Parking) Election/Change Form
The Parking Reimbursement Account allows you to set aside money from your paycheck on a pre-tax basis to pay for work-related parking expenses. That means you do not pay federal, and in most cases, state income tax, or FICA taxes on those dollars. Eligible expenses include those you incur at a parking lot or garage, or for metered street parking.

You can defer the cost of your monthly off campus parking expense (up to $300 per month) into your parking account. This monthly limit is set by the IRS and is subject to change. You may start, stop, or change your election at any time.

You may only be reimbursed for expenses incurred after you begin participating in the Plan. Expenses will be reimbursed after sums have been deferred from your pay to your account. Amounts remaining in your account following your termination of employment with the University will be forfeited.

I elect an amount to be deferred each pay period to a Parking Reimbursement Account on a pre-tax basis. I direct that this election be automatically renewed each pay period and that this amount continue to be deducted each pay period until I file a new form requesting a change or cancellation of deductions. The Internal Revenue Code limits the amount you may pay pre-tax for parking to $300 per month.
Desired Election Effective Date (Elections cannot be retroactive and must be submitted before the end of the pay period):
Please check off each box to indicate you understand and authorize the following:
I have read and understand the above information. I certify the information I have provided on all parts of this form is true and correct. I hereby authorize the payroll deductions of amounts elected.