Your paycheck for the last two weeks is shown below. Fill in the total hours worked, and the dollar

amounts, rounded to the nearest penny, every place where you see a dollar sign.

You worked $28$ hours the first week and $33\mathrm{.}5$ hours the second week. Your pay rate is $$16\mathrm{.}25$ per hour.

Federal income tax is withheld at $12\%.$ State income tax is withheld at $4\mathrm{.}3\%.$ Social Security and

Medicare $($FICA$)$ is withheld at $7\mathrm{.}65\%\mathrm{.}2\%$ of your salary is withheld for a health insurance plan. $3\mathrm{.}6\%$ is

withheld for a retirement plan. $0\mathrm{.}85\%$ is withheld for disability insurance. $0\mathrm{.}67\%$ is withheld for

unemployment insurance. And $1\mathrm{.}1\%$ is withheld for union dues.

EMPLOYEE NAME and ID

Hours worked this period