Complete this form so that your employer can withhold the correct California state income tax from your pay. Personal Information.Pursuant to the provisions of the Employee Relations Code of the County of San Bernardino and applicable. Eligible small employers (defined later) use Form 8941 to figure the credit for small employer health insurance premiums for tax years beginning after 2009. Services for you 120 or fewer days during the tax year aren't considered employees in determining FTEs and average annual wages. Why are you intercepting my tax refund? Revenue and Recovery participates in the State and Federal Tax Refund Intercept Programs. The couple filed a joint California resident income tax return. When you take a refund, you terminate your CalSTRS membership and forfeit your rights to all CalSTRS benefits.