CBS Administrators, LLC
SECTION 132 ELECTION FORM SMART AND FINAL
This enrollment form shall authorize payroll deductions on a pre-tax basis for qualified expenses under the Pre-Tax Transportation Benefit, Section 132(f). To participate in the Program, please complete and submit your form before the 20th of the month. Payroll deductions will begin with the 1st pay period of the following month.
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  • SECTION 132 TRANSPORTATION ELECTION AUTHORIZATION MASS TRANSIT AND PARKING BENEFIT

  • 2014 Commuter Benefit Maximum is $130.
    Please select your monthly election amount and enter the amount below, the maximum Commuter Benefit is $130 per month and the minimum is $50. Parking Benefit maximum is $250. Combined total for Commuter and Parking is $380.
  • I authorize MY EMPLOYER to deduct, on a pre-tax basis, per month from my paychecks, for the purpose of my participation in the Employee Transportation Program. (This program is described in Internal Revenue Code Section 132(f).
  • I authorize MY EMPLOYER to deduct, on a pre-tax basis, per month from my paychecks, for the purpose of my participation in the Employee Parking Benefit Program. (This program is described in Internal Revenue Code Section 132(f).
  • Authorization and Electronic Signature

CBS Administrators, LLC P.O. Box 129, New Almaden, CA 95042 408 323-4888 Phone 408 323-4999 Fax