INITIAL TRS-ACTIVECARE ENROLLMENT IS MAY 11 - JUNE 10, 2026

ACTIVE EMPLOYEES

All forms are maintained electronically to provide a more efficient, secure, and accessible experience for employees. Electronic forms allow for faster processing, reduce paperwork, and ensure accurate recordkeeping while minimizing delays. They can be completed and submitted from anywhere, making it easier to manage important tasks without the need for hard-copy paperwork.

All forms are secure. If you encounter an issue with a form, please email payroll@legacypca.com for assistance.

Click on the form name open the form. Expand form using the arrow to learn more about the forms use.

VIEW POST-EMPLOYMENT FORMS

VIEW OFFBOARDING FORMS

1095-C Request

Utilize this form to request 1095-C distribution. Submission of this form does not include W-2 mailings.

Pursuant to the Paperwork Burden Reduction Act (H.R. 3797) enacted on December 23, 2024, your 1095 Form will no longer be automatically mailed.

Address Update

This form will notify both payroll & benefits to update your address.

Additional Pay

Utilize this form to request payment for RTI, LPAC, RTI, GT, 5+ Prep, or other one-time supplemental duties not paid by timesheet. These forms are processed & paid on the 15th of each month.

Direct Deposit

The purpose of this form is to provide payroll with a financial institution of your choice to receive your salary deposits. Employees may also request secondary checking and saving deposits in addition to the primary depository account.

FMLA Request

Complete this form to begin the FMLA process. It is highly recommended that employees begin this process no later than 30 days prior to the first estimated day of absence.

HSA Request

This form allows employees enrolled in a high-deductible healthcare plan to enroll in an HSA or modify existing HSA contributions. This form may be completed at any time & is not restricted to Qualifying Life Events (QLE) or Open Enrollment(OE) periods.

Life Event/Name Change

Utilize this form to report a qualifying life event (QLE) to benefits. QLE notification must be received within 30 calendar days of the event to be eligible for benefit election updates.

Mentor Stipend

Utilize this form to submit a request for the Bi-Annual Mentor stipend.

Perfect Attendance Stipend

Utilize this form if you were not absent during the Fall or Spring semester's (respectively) to receive a $250 payment per semester with perfect attendance.

Split Premiums Request (Healthcare Only)

Utilize this form if you and your spouse are LPCA employees and would like to apply both LPCA contributions to a single healthcare plan premium.

Time Off Policy Acknowledgement

The purpose of this form is to provide payroll with your permission to utilize your paid time off (PTO) in place of an unpaid day (dock). This form will stay in effect for your employment duration unless revoked in writing.

Time Off Request (Outside of Policy)

The purpose of this form is to provide employees with the ability to request time off when unable to enter time off in Skyward Employee Access due to calendar restrictions or requested time off is outside of established policy.

True Time Timesheet Adjustment

Utilize this form only if you have been directed to do so by payroll or your campus manager. Most True Time corrections can be completed by returning the electronic timesheet.

W-4 Tax Withholding Form

Utilize this form to update your tax liability. This form affects the amount of taxes withheld from your paycheck This form has no bearing on Social Security or Medicare deductions.
Click here to view pages 2-5 of the W-4

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