ࡱ> ^b]zC bjbj\\ 4b>h>h dddddxxx8<xXHHHH|h<  `bbbbbb$ w#d@||@@ddHH4444@FdHdH`4@`444H@{^4L04##4#d4@@4@@@@@t@@@@@@@#@@@@@@@@@X *: October 25, 2023 June 30, 2025 Voluntary Employee Incentive Programs Worksheet EMPLOYEE IDENTIFICATION PART 1Employee NameEmployee Number Department NameCompany Number Job Class TitleJob Class CodePosition Number PROGRAM IDENTIFICATION PART 2 FORMCHECKBOX Reduced Work Week  FORMCHECKBOX Sporadic Leave  FORMCHECKBOX Unpaid Leave  FORMCHECKBOX Flexible Position Staffing Begin DateEnd DateDuration in Hours PERSONAL SERVICES SAVINGS PART 3 MFASIS ACCOUNT # __________________________ ACCOUNT NAME _________________________ C & O CodeQuarter 1Quarter 2Quarter 3Quarter 4Total        TOTALSAPPROVALS PART 4  FORMCHECKBOX Approved as Submitted by the Employee  FORMCHECKBOX Modified  FORMCHECKBOX Denied Prepared By:Date:  READ THE INSTRUCTIONS ON BACK PER 108t 10/23 INSTRUCTIONS Complete one of these worksheets for each Application you receive for Voluntary Programs. If an employee has applied for more than one program, complete a worksheet for each program. Complete a worksheet for every Application, whether the request is approved or denied. Should the terms of an individual's participation be changed after initial approval, submit a revised worksheet. Submit one copy to the Office of the State Controller and keep one copy for your records. Part 1 This part should be self-explanatory. Part 2 Check the one box for the program you are identifying. The Begin Date and the End Date are the dates the employee has requested - unless the request has been modified. If modified, enter the modified date. Part 3 Enter the actual C&O affected by each position. C&O should be at the same four (4) significant digits used in the Work Program. Enter the net dollar savings by C&O for each quarter as positive amounts in whole dollars. In calculating this figure, consider each compensation and benefit type affected that relates to a personal services C&O. Subtract any related costs from the projected savings to reach an accurate net savings figure. If a revised worksheet submission will reduce savings, include the net dollar cost of the change as a negative amount $ ($$$$) by C&O for each quarter. Calculate the compensation and benefit savings as follows: 1. Use the current Salary Schedule for the position (used to produce your personal services budget for the current fiscal year). 2. Use the employer retirement rates used to produce the personal services work programs for the current fiscal year and any subsequent changes in employer retirement rates. 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