Payroll Division Forms
Tax Information and Forms
State
 State Tax Withholding Form (DE4)
Form is for California personal income tax withholding only, and is used to compute the amount of taxes to be withheld from your wages. Submit form to your department payroll clerk.
State Tax Tables (Method A)
Employees can use this schedule to select an appropriate withholding amount. The Standard Deduction and Exemption Allowance Credit are already included in these wage bracket tables.
State Tax Tables (Method B)
This schedule may be used to calculate exact amount of withholding required. User must enter all appropriate exemptions, deductions, allowances, etc.
Federal
Federal Tax Withholding Form (IRS W-4)
Form is for Federal income tax withholding, and is completed so that your employer can withhold the correct federal income tax from your pay. Submit form to your department payroll clerk.
The IRS W-4 Calculator
This on-line program is meant to be an easy and accurate way to ensure a correct withholding amount. Not a replacement for the IRS W-4, some find this tool easier to use than the worksheets that accompany the W-4.
Federal Tax Tables (Pub 15)
Known as Circular E – Employer’s Tax Guide, this document explains tax responsibilities for the employer and also contains Wage Withholding and Advance Earned Income Credit Payment Tables.
Is My Withholding Correct? (IRS Pub 919)
With instructions and worksheets, this document helps one determine the proper amount of federal tax withholding, and how to adjust the amount if necessary by submitting a new W-4.
Medical and Dental Expenses (IRS Pub 502)
This publication explains itemized deductions for medical and dental expenses claimed on Schedule A.
Child and Dependent Care Expenses (IRS Pub 503)
This publication explains the tests you must meet to claim the credit for child and dependent care expenses.
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Employee Information & Forms
Human Resources Forms
Reimbursements
Automobile Mileage Claim
Form used to report personal automobile mileage reimbursement amounts. Submit form to your department payroll clerk.
Leaves of Absence
Request for Leave of Absence
Form is used to request leave of absence. This form is required, completed and signed by the employee, and submitted to department payroll clerk. Application for extended leaves, both paid and unpaid, must be completed by employee, or department if employee not available. Provides tracking for FMLA purposes and authorizes continued benefit coverage when appropriate per MOU’s and Resolution.
Medical Leave Checklist for Employees
Medical Leave Request/Status Report or a signed doctor’s note is required when an employee is absent due to a medical condition. Submit these documents to your department payroll clerk.
Catastrophic Leave
Catastrophic Leave Request
Form is used to request leave due to catastrophic situation after all other paid leave balances have been depleted. Submit form, signed by Department, to Human Resources.
Catastrophic / Decedent Leave Transfer
Form is used by employees wishing to donate their paid leave time to assist another employee whose paid time has been depleted due to a catastrophic event. Submit form to ACTTC-Payroll.
Catastrophic Leave / Decedent’s Benefit Request
Form used to donate time to another employee, or beneficiary of deceased employee, that is experiencing a catastrophic leave event. Submit to ACTTC-Payroll.
Domestic Partner
Domestic Partnership Affidavit (and Termination)
Submit this form to Auditor-Payroll to have domestic partnership officially recognized by the County of Sonoma. The third page of this document is used for terminating this official status with the County.
Other
Direct Deposit Application
Form is used to initiate automatic deposit of paychecks. Submit form, with a voided check, to ACTTC-Payroll.
Designation / Receipt of Check Upon Death
In case of death of employee, this form determines to whom the County sends final paychecks or other benefits such as insurance, deferred compensation, and retirement benefits. Submit form to ACTTC-Payroll for employee file.
Retirement Buy Back Information Request
Employee may be eligible to purchase and receive service credit for prior county service and medical leave of absence, or to redeposit contributions previously withdrawn. Submit form to ACTTC-Payroll.
Payroll Information Request Form
Use this form to request duplicate copies of W-2 forms, research of deferred compensation catch-up eligibility, or other earnings information. Submit form to ACTTC-Payroll.
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Health Care Flexible Spending Account (Health FSA)
 Flexible Spending Account Calculator
Flexible Spending Account Programs
This document contains a general explanation of Health and Dependent Care Flexible Spending Accounts. Employees may set up an automatic pre-tax contribution from their paychecks to a FSA account from which they would be reimbursed for eligible health or dependent expenses.
Flexible Spending Accounts – Tips
Document provides tips to make it easy for employees to use health and dependent care tax-exempt reimbursement account, and dispels some of the myths and worries about the program so that you too can enjoy the tax savings.
Claim Due Dates & Reimbursement Schedule
This document shows the claim payment schedule for the health and dependent care reimbursement programs. Completed claims received by Auditor-Payroll by payday will be processed and paid within two weeks whenever possible.
Direct Deposit Application
Use this form to set up a direct deposit for your health and dependent care reimbursement checks. Submit form to ACTTC-Payroll.
Flexible Spending Account "Change" Form (Change in Election)
Form may be used to change the amount of pre-tax contributions for tax-exempt health and dependent care. Change is only allowed within 30 days of a change-in-election event such as marital status, number of dependents, employment status or eligibility. Submit form to ACTTC-Payroll.
Termination and FSA
Explanation on how termination affects participation in the tax-exempt reimbursement program for health and dependent care, and what must be done to stop deductions from paycheck.
Health FSA Reimbursement Request Form
This form is used to submit reimbursement requests from the Health FSA Program. Submit original form to ACTTC-Payroll and retain a copy for your records.
Documentation Guidelines (Health FSA)
These guidelines provide instructions for obtaining timely reimbursement for your Health FSA expenses by describing the procedure to follow, and providing examples of required documentation for submitting claims. Submit Health FSA Reimbursement Request Form and copies of bills and documentation to ACTTC-Payroll.
Medical & Dental Expenses (IRS Pub 502)
This is a general information document of IRS guidelines of medical and dental expenses that can be claimed in the current tax year.
FSA Enrollment and Salary Reduction Authorization — Annual Enrollment 2012
FSA Web Flyer
FSA Enrollment and Salary Reduction Authorization — Mid-year, Plan Year 2011
FSA Enrollment and Salary Reduction Authorization — Annual Enrollment 2012
FSA Web Flyer
Dependent Care Assistance Program (DCAP)
DCAP Reimbursement Request Form
This form is used to submit reimbursement requests from the FSA Dependent Care Assistance Program (DCAP). Submit original form to ACTTC- Payroll and retain a copy for your records.
Sample Dependent Care Receipt
This is an example of a day-care receipt, showing what information is required.
Child & Dependent Care Expenses (IRS Pub 503)
This is a general information document of IRS guidelines of child and dependent care expenses that can be claimed in the current tax year.
DCAP Enrollment and Salary Reduction Authorization — Mid-year, Plan Year 2011
FSA Enrollment and Salary Reduction Authorization — Annual Enrollment 2012
FSA Web Flyer
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Accounting / Internal Payroll Processing Forms
Sonoma County Payroll Calendar
The ACTTC-Payroll Calendar, showing pay dates, pay-period end dates, and holidays. Also includes calendars for 2000 through 2020.
Sonoma County Bi-Weekly Payroll Schedule
The ACTTC-Payroll Calendar, in table format, showing payroll period number, payroll start dates, payroll end dates, pay dates and holidays. Also includes calendars for 2001 through 2020.
Payroll Clerk Phone List
Phone numbers and other contact information for current Payroll Clerks.
Payroll Security Access Authorization Form
Use this form to request security access for different Payroll data and activities. Submit to ACTTC-Payroll.
Extra Help Insurance Dates
This document lists the premium due dates for extra help employees who have Kaiser Health Insurance.
Lost Warrant Affidavit
Use this form to report a lost or stolen warrant (i.e. check), and/or to obtain a duplicate warrant. Submit to ACTTC-Payroll.
Back Pay Form
Use this form to request back pay. Submit form, and attachments, to ACTTC-Payroll.
Promissory Note
Submit this form to your department payroll clerk when an overpayment from the County to you has occurred. Balances still owed to the County may be taken from final paycheck if not repaid prior to termination.
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