New Jersey Department of Health

Division of HIV, STD And TB Services

FRINGE BENEFIT BREAKDOWN

F.I.C.A.	%
Health Insurance	%
Unemployment Insurance	%
Disability Insurance	%
Life Insurance	%
Worker’s Compensation	%
Pension/Retirement	%
Other (Explain):
%
TOTAL *	%

*This amount must equal the percentage shown on Schedule A, Page 1 of 2.

DHAS-2

JUL 12

DHAS-2, FRINGE BENEFIT BREAKDOWN

DHAS-2, fringe benefit, fringe benefit breakdown, HIV, STD and TB Services

EWHITE

2002-10-10

NJDOH