Payroll Customer Service Form
Company:
*
Please Select
HCS
A&J
Direct Care
A Better Life
Opened By:
*
First Name
Last Name
Your Email:
*
example@example.com
Came from:
*
Phone
Walk-In
Caregiver ID Number.
*
Phone Number
*
Language:
*
Please Select
Select
English
Russian
Spanish
Chinese
Type of Inquiry:
*
Electronic Timesheet Request
Pay Check Has Incorrect Amount
Timesheet Issue
Mailed Timesheet But Did Not Receive
Does Not Know Where to Send Timesheet
Insurance
Taxes Questions
Missing Check or Did not Get Check
Did Not Get Paid
Missing Visits on Check
Direct Deposit
Metro Card Question
Needs A Letter of Employment
Needs Pay Stubs
Beniflex Card Question / Issue
Potential DOL Threat
Direct Deposit Form
Housing Form
Hold W2’s or Paychecks
Other
Other:
Notes:
Submit
For Finance Use Only:
Finance Representative:
Please Select
Select
Stephanie
Marina
Dayton
Ticket Status:
Please Select
Open
Closed
Action:
Please Select
Select
Spoke to employee
Left Message
Number Is Invalid
No Answer
Notes:
Should be Empty: