HomeMy WebLinkAboutOCDSB 199 - XY Leave Notification Form Elementary 2025OCDSB #199 X/Y (Self-funded) Leave Notification page 1
OCDSB 199 X/Y Leave Notification
(Due no later than March 1st, prior to start of leave)
FOR EMPLOYEE COMPLETION
Employee Name ___________________________ EIN _________________ SIN _________________
Home Address _______________________________________________________________________________
Leave Plan (e.g. 4/5) __________ Leave Start __________________ Leave End __________________
Job Title _______________________________ Work Location ____________________________________
Please check the appropriate option, below, to notify Employee Services of your self-funded leave intent.
1.) □ I am proceeding on my self-funded leave. Please process payment as noted below under Disbursement.
Disbursement: The money you have accumulated may be paid to you in one or two lump sum payments. You
may wish to consider balancing your disbursement to reflect your normal yearly salary as these funds are subject
to all applicable deductions (CPP, tax, pension, and federation fees).
EXAMPLES
All Employees (12 or 10-month X/Y Leaves)
Disbursement: Lump Sum 1: 40% (Sep 1st)
Lump Sum 2: 60% (Jan 1st)
Secondary Teachers Only (6-Month X/Y Leaves)
Disbursement for August - January: 90% (Aug 1st) & 10% (Jan 1st)
Disbursement for February - July: 100% (Feb 1st)
Disbursement Options
•One lump sum at 100% or
•Two lump sums
Payment
Percentage Options
•100%
•40% / 60%
•other
*Percentages based on
5% increments only ex.
45%/55% or 35%/65%
NOT 42%/58%
Processing Date(s)
(YY/MM/DD) *
NOTE: Payment
WILL take 10-15
business days
from the Process
Date(s) you choose
Payment Method Options
•Cheque mailed to home
•Direct deposit (same as payroll deposit)
•Should you need to change your direct
deposit bank account, please submit
OCDSB #298 Direct Deposit Change
form
Lump Sum #1 %
Lump Sum #2 %
* Process Dates: The Process Date represents the date that funds will be released to the OCDSB. The
Payroll Department will issue your payment on the first available pay date, following the Process Date.Typically, this is the second pay date of the month. Ex: Process Date of Sept 1, expect funds mid Sept.
2.) □ I am deferring my self-funded leave to next year. Note: Deferral is limited to one year only (6/7 leave plan
cannot be deferred)
3.) □ I am withdrawing from my self-funded leave. Revenue Canada requires the OCDSB to make one
payment, subject to all applicable deductions, within 60 days of withdrawal. This payment will be made via direct
deposit to your bank account on file with the OCDSB. Should you wish to change this account, please submit
OCDSB #298 Direct Deposit form.
Employee Signature: __________________________________ Date: __________________________
OCDSB #199 X/Y (Self-funded) Leave Notification page 2
Your Credit Union
14 Chamberlain Avenue
Ottawa, Ontario
K1S 1V9
Re: Instructions for Payment to Employees Participating in Employee-Funded Sabbatical Leave Plan
Attention: Tracy Quesnel, Investment Administrator
Please forward a cheque to the Ottawa-Carleton District School Board as per the option(s) noted below. Upon
receipt, Payroll will remove the appropriate deductions (CPP, Income Tax, Federation Dues) and issue a separate
cheque to the Employee.
Employee Name ___________________________ SIN _________________ EIN _________________
Home Address _____________________________________________________
Leave Start __________________ Leave End __________________
Employee is proceeding on Self-Funded Leave
Pay out funds plus accrued interest in lump sum(s) in trust for the above listed OCDSB Employee as follows:
1st Payment % (Sept 01) _____________ Effective Date: ____________________
2nd Payment % (Jan 01) : _____________ Effective Date: ____________________
Employee is withdrawing from Self-Funded Leave
Pay 100% of the principal, plus accrued interest, in trust for the above listed OCDSB Employee.
Please forward cheques to the attention of:
Ottawa-Carleton District School Board
Payroll Department
133 Greenbank Road, Nepean, Ontario K2H 6L3
Attention: Assistant Payroll Supervisor
Yours Sincerely,
Dianne Robertson, HR Team Manager
Employee Services
Ottawa-Carleton District School Board
cc.Assistant Payroll Supervisor
Employee
PC&L File
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