Are you looking for a comprehensive overview of the TSA Form 1158 1? You have come to the right place! This post outlines what this form is, when it is used, where it needs to be submitted, and any requirements that need to be met in order to move forward with your application. Being informed about all aspects of Tsa Form 1158 1 can save you time and make sure that your submission process goes as expected. Read on to learn more about this important document!
| 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) |
|||
|
|
|
|
|
|
Home Address: (Number and Street) |
|
(City) |
|
(State) |
(Zip Code) |
|
|
|
|
|
|
Contact Number: ( |
) |
- |
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 |
Page 1 of 1 |
