Article Guide
The Access-A-Ride NYC Application form is an essential document for individuals seeking to enroll in the Commuter Benefits Program, specifically designed for those eligible for the MTA New York City Transit Access-A-Ride program or other paratransit services. To successfully complete the application, applicants must provide key personal information, including their name, address, and employee identification number. Additionally, the form requires proof of eligibility, such as an Access-A-Ride Acceptance Letter or Photo ID. Applicants can also specify their desired monthly deduction amount for payroll, which will be used to fund their transit needs. The form offers options for new enrollment, changes to personal information, and even cancellation of deductions. It is crucial to submit the completed form along with required documentation to the designated Transit Benefit Coordinator. After enrollment, participants can manage their accounts through WageWorks, ensuring they receive their transit benefits efficiently. Understanding the details of this application process can help individuals navigate their transportation options with confidence.
Preview - Access A Ride Nyc Application Form
THE CITY OF NEW YORK COMMUTER BENEFITS PROGRAM
Submit completed form and required documentation to: Your Agency TransitBenefit Coordinator. |
www.NYC.gov/payroll |
www.getwageworks.com/nyc |
IMPORTANT INFORMATION FOR EMPLOYEE
Your enrollment in the Commuter Benefits Program
As proof of eligibility, copies (do not send the originals) of the following must be attached to this enrollment: MTA New York City Transit
Two business days after you enroll in the
EMPLOYEE ACTION
NEW
(Enroll)
CHANGE PERSONAL INFORMATION
(Change Mailing Address, Email or Telephone)
CHANGE DEDUCTION
(Change Amount Deducted from Pay each Month)
SUSPEND DEDUCTION
(Temporarily Stop Deduction from Pay)
CANCELLATION
(Terminate Payroll Deduction)
EMPLOYEE IDENTIFICATION (All fields in this section are required and must be filled out completely. Please Print.)
Employee Reference #* |
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Name (First/Middle/Last) |
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Address Line 1 |
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Address Line 2** |
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City/State/Zip |
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Email Address |
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Telephone |
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* Located on your pay statement or check stub. |
** Apt.#, Fl.# or Box# if applicable. |
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Please enter the total amount, in dollars and cents, you want deducted from your pay each month.
Monthly Deduction Amount
$
SUSPEND
Submit at least 2 weeks before you want to suspend your deduction. Please note this will only suspend your payroll deduction. To also suspend your
MONTH DAY |
YEAR |
MONTH DAY |
YEAR |
PAY DATE TO SUSPEND DEDUCTION |
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PAY DATE TO RESUME DEDUCTION |
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EMPLOYEE CERTIFICATION
I hereby authorize the City of New York to deposit my payroll deduction as indicated above into my WageWorks Commuter Benefits Transit Account.
I also grant authorization for the reversal of a credit to my account in the event the credit was made in error. I understand that, under the “National Automated Clearing House Association” operating guidelines and rules, the City of New York can only reverse the amount of the incorrect direct deposit.
I understand that participation in the
I understand, according to the Internal Revenue Code, that the average monthly amount of my transportation deductions should not exceed my average monthly cost of public transportation to and from work. If my average monthly cost of public transportation to and from work should change, I will change my deduction plan to accommodate my new circumstance. Furthermore, no reimbursement will be provided for
I understand that $3.05 per month, to cover administrative costs of the program, will be paid by the City of New York to WageWorks on my behalf and will be added to my taxable earnings as a fringe benefit each month my account is debited for purchases and/or charges. The administrative charge is
I grant authorization for the City of New York to provide my enrollment information, including mailing address, phone number and
I understand that this authorization will remain in effect until I submit a new request for a change or cancellation.
I understand that my Commuter Benefits Transit Account balance and information will be maintained by WageWorks. Paratransit Service coupons or vouchers must be ordered directly through WageWorks. Transit Account order processing and balance information is accessible online at www.wageworks.com or by calling WageWorks Customer Service at
MONTH DAY YEAR
Employee Signature |
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AGENCY PAYROLL SECTION
Payroll #
Personal information updated in NYCAPS (check all that apply): |
MONTH DAY YEAR |
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Mailing |
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Phone |
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Address |
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Address |
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NYCAPS ENTRY DATE |
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I certify that the above data was entered in NYCAPS via EForms:
Prepared By (Please Print) |
Signature |
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Form Characteristics
| Fact Name | Details |
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| Eligibility Requirement | Enrollment in the Access-A-Ride program requires proof of eligibility, such as an MTA Acceptance Letter or a Photo ID. |
| Documentation Submission | Submit the completed form and required documents to your Agency Transit Benefit Coordinator. |
| Deduction Authorization | Participants must specify the monthly deduction amount for their payroll, which will be deposited into a WageWorks account. |
| Administrative Fee | A monthly administrative fee of $3.05 will be added to taxable earnings as part of the program. |
More PDF Templates
Form Nyc-2 - Demands precise documentation of the date of the IRS or New York State's final determination of the income adjustment.
Prevailing Wage Reporting - It streamlines payroll reporting for contractors, making compliance with public work laws more manageable.