Navigating through the various forms and procedures required by the Department of Homeland Security (DHS) can seem daunting, especially when it comes to matters that directly influence the lives of its workforce, such as the processing of union dues. The TSA 1158-1 form serves a critical function within this framework, facilitating the voluntary deduction or cancellation of American Federation of Government Employees (AFGE) union dues for Transportation Security Administration (TSA) employees. This form represents a straightforward yet essential mechanism for TSA employees to manage their union dues, requiring careful completion of several sections by both the employee and the AFGE Local Representative. Additionally, it underscores the partnership between TSA staff and the AFGE, emphasizing the importance of clear communication and mutual understanding in financial transactions related to union membership. The form also contains a privacy act statement, acknowledging the sensitive nature of the information it handles and the specific legal basis for its collection, processing, and potential sharing. It is designed with the employees' privacy in mind, ensuring they are fully informed of the form's purpose, the use of their personal information, and the voluntary nature of providing such information, including their Social Security Number (SSN). Understanding and completing the TSA 1158-1 form correctly is essential for any TSA employee looking to adjust their union dues status, making it a vital document within the TSA's administrative processes.
| Question | Answer |
|---|---|
| Form Name | Tsa Form 1158 1 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | tsa form 1158 1, cancellation afge print, tsa 1158 1, tsa form 1158 |
DEPARTMENT OF HOMELAND SECURITY
Transportation Security Administration
VOLUNTARY DEDUCTION / CANCELLATION OF AFGE UNION DUES
INSTRUCTIONS: Sections I, II, and IV are to be completed by employee. Section III must be completed by the AFGE Local Representative, and Section V will be completed by the TSA Office of Human Capital (OHC) HRAccess. Please type or print the required information in the spaces below. Human Resources/Payroll Specialist will retain the original and provide a copy to the employee.
SECTION I. Employee Information
Last Name: |
First Name: |
SSN: (full) |
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Home Address: (Number and Street) |
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(City) |
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(State) |
(Zip Code) |
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Contact Number: ( |
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Airport Code/Office:
Personal email address: (optional)
SECTION II. Voluntary Deduction Request
Labor Organization – American Federation of Government Employees (AFGE)
Action Requested: (check only one box)
Establish AFGE Dues Deduction – Employees must contribute dues for a minimum of one (1) year.
Cancel AFGE Dues Deduction – Cancellations must be submitted during the time frame specified in Section IV.
SECTION III. Union Representative Only
Amount to be Deducted
ID or Local Number: (if applicable):
Union Representative Name |
Union Representative Signature |
Date |
SECTION IV. Employee Acknowledgment
I hereby authorize TSA to deduct from my pay each pay period the amount certified above as the regular dues of the AFGE Local, and to remit such amount to AFGE in accordance with its arrangements with TSA. I understand that this authorization will become effective the pay period following its receipt in the TSA Payroll Office. I understand that the AFGE has the right to change the amount to be deducted when certified by AFGE at any given time after my membership begins. I further understand I must resubmit this form to cancel dues deductions for AFGE, and that I may only cancel this dues deduction after my initial
Signature |
Date |
SECTION V. TSA Payroll Office Use ONLY
Voluntary Deduction Code:
Collection Code:
TSA Payroll Office Processing Instructions – Forward to:
TSA HRAccess Shared Service Center
Metroplace1, 2650 Park Tower Drive, Suite 201
Vienna, VA
PRIVACY ACT STATEMENT: AUTHORITY: 49 U.S.C. § 114(n); E.O. 9397. PRINCIPAL PURPOSE(S): To request that union dues be deducted from your pay, or cancel union dues from being deducted from your pay, and notify AFGE accordingly. ROUTINE USE(S): Information may be shared with the Department of the Treasury, with employees of AFGE, or for other routine uses listed in the Transportation Security Administration’s system of records notice, DHS/TSA 022 National Finance Center (NFC) Payroll Personnel System. DISCLOSURE: Voluntary; failure to furnish the requested information may result in an inability to process your request. Your SSN is requested by AFGE for reporting requirements. Supplying your SSN is voluntary, but failure to provide it may result in inability to process your payroll deduction/cancellation request.
TSA Form |
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