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Fillable Form Accrued Benefits Statement

An Accrued Benefits Statement is a document of income employees received but the income is not immediately paid. It may also refer to a coverage earned on a pension plan.

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What is an Accrued Benefits Statement?

An Accrued Benefits Statement or Accumulated Benefits Statement is a document that details all of an employee's accrued benefits.

Accrued benefits are benefits that a worker has earned due to their service or other conditions, which are paid to the employee at a later period. Sick pay, personal time off, and other incentives that employees can earn when they work longer are examples of these types of benefits. You may lose all of your earned time off if you leave or get terminated from your job rather than retiring. The state laws and your employer's policies regarding compensation for unused sick or vacation time will determine whether or not you get compensated for such time.

Accrued benefits may also refer to coverage on a pension plan obtained by an employee based on years of service with an employer. Pension plans are becoming increasingly rare in the private sector in the United States, as companies have shifted to tax-advantaged retirement accounts.

Where to get an Accrued Benefits Statement template?

An Accrued Benefits Statement is usually requested by an employee and is provided by the employer. It can also be standardized by a company. If you are an employer, you can create your own accrued benefits statement, providing all the information needed in the document.

Accrued benefits statement templates are also available online. For your convenience, an Accrued Benefits Statement that you can electronically fill out is available on PDFRun.

How to fill out an Accrued Benefits Statement template?

Here is a detailed guide on how to fill out an Accrued Benefits Statement template.

Employee Name

Enter the name of the employee.


Enter the department where the employee is assigned.


Enter the job title of the employee.

Benefits accrued as of

Enter a date to determine benefits to be accrued.

Vacation days

Enter the number of unused vacation days.

Vacation pay

Enter the amount of vacation pay of the employee.

Sick hours

Enter the number of unused sick hours of the employee.

Sick pay

Enter the amount of your sick pay of the employee.


Enter the amount of stocks of the employee.


Enter the amount of the employee’s pension.

Profit Sharing

Enter the amount of the employee’s profit sharing.

Life Insurance

Enter the amount of the employee’s life insurance.

Surrender value of insurance

Enter the amount of the employee's cash surrender value of insurance.

Severance pay

Enter the amount of the employee’s severance pay.


Enter amounts from other sources.


Enter additional notes in the statement, if applicable.


Enter the date the statement was signed

Supervisor Signature

Affix the signature of the supervisor

Type of employee benefits

Different companies have different benefits for their employees. Here are some different types of benefits usually offered to an employee:


Medical insurance covers the costs of physician and surgeon fees, hospital rooms, and prescription drugs. Dental and optical care might be offered as part of an overall benefits package. It may be offered as separate pieces or not covered at all. Coverage can sometimes include the employee's family. Employers usually pay all or part of the premium for employee medical insurance through an employer.

It usually covers the following:

  • Dental Insurance — Includes dental cleanings, diagnoses, treatments, and other procedures
  • Vision Insurance — Includes vision care expenses like routine eye exams, prescription glasses, contact lenses, diagnostics, and treatment.
  • Flexible Spending Account — A specific account into which employees deposit funds to pay for some out-of-pocket healthcare expenses.
  • Critical Illness Insurance — A lump-sum cash payment to assist in covering expenditures for a qualifying serious illness
  • Health Reimbursement Account (HRA) — A group health plan financed by the employee, the employer. This means workers get tax-free reimbursement for eligible medical costs up to a certain dollar amount each year.
  • Health Savings Account (HSA) — A pre-tax savings account that allows workers to put money aside for qualifying medical costs.
  • Hospital Insurance — A health insurance for hospital expenses.


When a worker is unable to do their job due to illness or accident, disability insurance covers all or a portion of their salary. This benefit is not usually available. Disability insurance is classified into two types:

  • Short-term disability — This type of coverage protects a portion of your income for a short period when an accident, sickness, or other disability occurs. For example, someone hurt in a bike accident would be offered a few paid weeks to recover.
  • Long-term disability — The insurance pays compensation to an employee who is unable to work due to a long-term or permanent sickness, accident, or impairment. Employees eligible for long-term disability payments receive these benefits until they reach retirement age.


Life insurance protects your family when you die. Benefits are paid in full to the current policy beneficiaries, who are usually a spouse or children.

If your company offers a group plan, you may be able to obtain life insurance from them. Company-sponsored life insurance policies are required for nearly all full-time employees in medium and large businesses across the country. You may also buy it privately, although this is generally more expensive.


Retirement benefits are benefits to provide individuals with an income or pension after their careers come to an end. It has two general categories

  • Defined benefit plans — It is pre-determined based on pay and years of service. In this plan, the employer is responsible for carrying the financial risk in these programs. It is also known as a pension plan.

  • Defined contribution plans — In this benefit, employer or employee payments are defined, but the benefit amount is typically tied to investment returns that are not guaranteed. An example is a 401k plan.

Paid Time Off

Paid time off (PTO) is a benefit program provided by many companies that enable employees to take a certain number of days off while still receiving pay. Absences due to vacation, sickness, or personal reasons are typically included.

The most common examples are:

  • Sick leave — Applicable for employees who can’t report to work due to sickness or disability.
  • Vacation leave — Applicable for employees going on a vacation.
  • Maternity leave — Applicable for mothers recovering from giving birth.
  • Rehabilitation leave — Applicable for employees who have sustained injury and disability while on duty

Why are employee benefits important?

Offering benefits to your employees is essential since it reflects that you care about their general health as well as their future. A good employee benefits package may contribute to attracting and retaining employees. Benefits might help your company stand out from others. When a company encourages an employee to prioritize his or her health, it may result in fewer sick days, fewer medical visits, and more time spent working in your company, bringing their best self to work every day.


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