Summary

The Authorization to Cancel / Terminate Voluntary Payroll Deductions form allows an employee to formally request the cancellation or termination of one or more voluntary payroll deductions previously authorized. This form ensures that the employee’s request is properly documented and processed in accordance with payroll timing requirements and applicable law.

Description

This form serves as a formal written authorization from the employee instructing the employer and ChampionPEO to discontinue specific voluntary payroll deductions. It identifies the type of deduction(s) to be canceled and acknowledges that cancellation requests are subject to payroll processing deadlines. The form also clarifies that mandatory deductions required by law—such as taxes, court-ordered garnishments, child support, or tax levies—cannot be canceled using this form.

Additionally, the form includes an acknowledgment regarding any outstanding balances that may remain at the time of cancellation and confirms that any lawfully permitted deductions or repayment methods may still apply.

Examples of Use

• An employee requests to stop repayment of a payroll advance through ongoing payroll deductions.
  

• An employee no longer wishes to have union dues deducted from their paycheck.
  

• An employee requests cancellation of deductions related to uniforms, tools, or company property.
  

• An employee terminates employment and requests cancellation of remaining voluntary deductions effective with a future payroll cycle.
  

Submission Instructions

Once completed and signed, the form should be submitted to ChampionPEO’s payroll department for processing. Clients should email the completed form to payroll@championpeo.com.