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Form application waive 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out Section A, Participant Information. Provide your name, Employee Identification Number (EIN), and contact details as indicated.
- If you wish to start pretax treatment, complete Section B. Read the guidelines carefully and initial to confirm your understanding of the implications.
- If you are waiving pretax treatment because you have previously elected it, fill out Section C. Again, ensure you understand the conditions before initialing.
- In Section D, sign and date the form to authorize payroll deductions based on your selection in either Section B or C.
- Finally, submit the completed form by mailing it to HRSSC at the address provided in Section E.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2015 | 4.8 Satisfied (271 Votes) |
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