*” indicates required fields

New Hire / Employee Change

New employee or current employee change*
HUB Set-up:
MM slash DD slash YYYY
MM slash DD slash YYYY
DOB & Email Required for HUB Activation
Federal Filing Status*
Use information found on Form W-4 (do not send W-4 to PaySmart, keep in employee records)
Step 2 Option C

Township & School district are required information found on certificate of residency.
Missing information will result in processing delays.
Withhold LST?
If No, must provide exemption form
Eligible for time off benefits?
Payroll Deductions
Start Date
Balance Due
  • PaySmart is not responsible for omitted or incorrect information contained on this form
  • DO NOT send W-4, I-9, or Certificate of Residency to PaySmart
  • Keep W-4 and Certificate of Residency with your employee records
  • Keep I-9s together in a separate file, retain for 3 years from hire date or 1 year from termination date, whichever is longer