Payroll and Benefit Forms

Payroll and Benefit Forms

Payroll Information
  • Mandatory Direct Deposit Notice
  • Direct Deposit Authorization Form
  • Advice of Pay    

    If you feel you absolutely must receive a paper copy of your direct deposit notice, it will be necessary to complete an “Advice of Pay” form, if you do nothing, you will, in effect, agree to “go paperless”. Going paperless will result in a tremendous savings to the District both in time, paper and postage costs. Your cooperation in making this change is greatly appreciated.

Time Sheet Pay Forms

Occasionally due dates must be changed due to holidays, if this is necessary there is district wide email notification before the end of the work period that is affected.

Late timesheets cause more work because they are out of the default period end dates for payroll; this affects retirement(TRA &PERA)reporting not to mention that monthly/fiscal budget spending can not be reflected accurately.

 Time Sheet Substitute Teacher    

  • Follow color coding & due dates for the period of time being reported (Pink or Blue)

Tax Information

Federal W-4 Withholding Allowance Certificate

MN W-4 Withholding Allowance Certificate

Social Security Card Application

MN Revenue Withholding Tax Tables

IRS Federal Tax Withholding Table

Retirement and Tax Sheltered Annuities

Per School Board Policy, "Under no circumstances shall a company or any of its agents solicit school district employees on District owned property or during the employees work day. The only exception to this will be when the Business Office has requested participation by companies at staff educational events."


Procedure for TSA Changes

Health Insurance Information

Blue Cross Blue Shield - From this link

Click on Find a doctor- Our Traditional $100 and $300 CMM plans are both in the BCBS network Blue Cross Aware; the $1200 CMM (Plan 830) and Plan 860 are both in the Minnesota Service Cooperative network.

Click on Prescription Drugs and then Search the drug list (formulary).
All ISD#656 plans follow the
BCBSMN FlexRx Drug list.

**2017-2018 Health Insurance Plans**

Minimum Value Plan $6350/$12700
Plan 860 $3250/$6500
Plan 830 $1200/$2400
300 CMM $300/$900
Trad 100 $100/$300

How Much Will Insurance Cost Me: 


ACA-HealthCare Reform

Insurance Liaison between ISD 656 and BCBS.

Contact Information:

Dental Insurance

Enrollment Form
Membership Maintenance Form
Dental Dental Information Form

Flex/VEBA/HSA Information


Questions? Contact SelectAccount Customer Service 1-800-859-2144
Monday - Friday 7am - 7pm (Central time)

Mail or Fax completed claim form and appropriate statements/receipts to:
PO BOX 64193
ST PAUL MN 55164-0193
FAX: 1-866-231-0214

Long-term Disability Insurance Certificates

Health Care Savings Plan (HCSP)

Participation Criteria

Union Employees
. Amounts to be deposited into the account must be negotiated or agreed to by both the bargaining unit and the employer.

Non-Union Employees. Amounts to be deposited into the account must be included in a written personnel policy and must coverall employees covered under the personnel arrangement.

Administered by:
Minnesota State Retirement System
60 Empire Drive, Suite 300
St. Paul, MN 55103-1855

Employee Resource Program

Combined Claim and Claim Verification Form

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