Pre-tax Benefit Option Commuter Choice Employee Survey
Recent IRS tax code changes make it possible for employees to have up to $65 per month of the cost of commuting on public transportation withheld from their paychecks as a tax-free benefit, similar to flexible spending accounts for health and childcare. Our organization is considering offering a Commuter Choice Pre-tax Benefit Program for employees who commute on public transportation. Please complete the questions below concerning your commuting patterns and return to your supervisor by (DATE): _____________.
Name:_________________________
Payroll or Social Security Number: ____________
Office/Department:____________________________ Ext. ______
1. Primary mode of transportation used in your commute to work:
| A. Public Transit |
B. Vanpool |
C. Carpool |
D. Drive Alone |
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| E. Bicycle |
F. Walk |
G. Rollerblade |
H. Other (Specify) |
If the answer to #1 was either A. or B., then how many roundtrips per week do you take on public transit or by vanpool? _________
2. If you use public transit, which transit system(s) do you use to commute to work? List all that apply.
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3. What type of fare media do you use while riding public transit? Circle all that apply.
| A. Monthly pass |
B. Weekly pass |
C. Single Ticket or Farecard |
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| D. Multi-ride Ticket or Farecard |
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E. Tokens |
F. Other (Specify) |
4. On average, how much do you spend per month using public transportation (including vanpools) in your direct commute to work (not including additional stops such as dependent care facilities, shopping, errands, etc.,)? $_________
5. On average, how many days per month do you use public transportation (including vanpools) in your direct commute to work? _____________
6. If you drive to a public transit station, a park and ride lot, or to a vanpool staging area, how much, on average, do you spend on parking at these facilities each month? $___________
7. If you drive now, would you use public transportation, if the company offered a "pre-tax " Commuter Choice benefit?
Yes No
8. If you were to use public transportation, would any part of your trip include parking at a public transit station, park and ride lot, or vanpool staging area? Yes No
9. How much of your income, up to $65 per month, would you choose to exchange as a Commuter Choice pre-tax benefit? $_____________
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