Form application waive 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section A, Participant Information. Provide your name, Employee Identification Number (EIN), and contact details as indicated.
3. If you wish to start pretax treatment, complete Section B. Read the guidelines carefully and initial to confirm your understanding of the implications.
4. If you are waiving pretax treatment because you have previously elected it, fill out Section C. Again, ensure you understand the conditions before initialing.
5. In Section D, sign and date the form to authorize payroll deductions based on your selection in either Section B or C.
6. Finally, submit the completed form by mailing it to HRSSC at the address provided in Section E.

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