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This document is required for employees and their spouses/domestic partners to certify tobacco use in order to qualify for participation in the Wellness Program and lower premiums.

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How to fill out DriveTime Tobacco Use Affidavit

1. Obtain a copy of the DriveTime Tobacco Use Affidavit form.
2. Read the form carefully to understand all sections that need to be filled out.
3. Provide your full name, address, and contact information in the designated fields.
4. Indicate your tobacco use status by checking the appropriate box (e.g., 'Yes' or 'No').
5. If you are a tobacco user, specify the type of tobacco products used and frequency of use.
6. Sign and date the affidavit to certify that the information provided is accurate.
7. Submit the completed affidavit as instructed by DriveTime.

Who needs DriveTime Tobacco Use Affidavit?

1. Any individual applying for a vehicle financing or leasing agreement with DriveTime must complete the affidavit.
2. Individuals who are tobacco users or who have previously used tobacco products.
3. Potential customers seeking to demonstrate their compliance with DriveTime’s policies regarding tobacco use.

People Also Ask about

Do you use tobacco in any form?

Cigarette smoking is the most common form of tobacco use worldwide. Other tobacco products include waterpipe tobacco, cigars, cigarillos, heated tobacco, roll-your-own tobacco, pipe tobacco, bidis and kreteks, and smokeless tobacco products.

What does it mean when it says I attest that I am a tobacco user?

Tobacco attestation is the section of the enrollment process for the State Health Plan that asks about your tobacco use. All State Health Plan members MUST complete the tobacco attestation to avoid the default surcharge of $60 a month for the next year's premiums.

What qualifies as a tobacco user?

A tobacco user is a person who has used any tobacco products, as defined in the policy, five or more times within the past three consecutive months.

What does it mean to be a passive user of tobacco?

Passive smoking means breathing in other people's tobacco smoke. The smoke drifting from a lit cigarette plus the smoke breathed out by a smoker is called second-hand smoke or environmental tobacco smoke. Second-hand smoke is a serious health risk for both those who smoke and those who do not.

What is the short note of tobacco?

A plant with leaves that have high levels of the addictive chemical nicotine. After harvesting, tobacco leaves are cured, aged, and processed in various ways. The resulting products may be smoked (in cigarettes, cigars, and pipes), applied to the gums (as dipping and chewing tobacco), or inhaled (as ).

Is vaping considered tobacco use?

A tobacco user is someone who has used tobacco more than five times in the previous three months. Vaping and e-cigarettes are also considered nicotine products and tobacco use.

What is meant by tobacco use?

Tobacco use may be defined as any habitual use of the tobacco plant leaf and its products. The predominant use of tobacco is by smoke inhalation of cigarettes, pipes, and cigars. Smokeless tobacco refers to a variety of tobacco products that are either sniffed, , or chewed.

For pdfFiller’s FAQs

What is DriveTime Tobacco Use Affidavit?

The DriveTime Tobacco Use Affidavit is a legal document that certifies an individual's tobacco use status, required for compliance with certain regulations.

Who is required to file DriveTime Tobacco Use Affidavit?

Individuals who are applying for or renewing a contract with DriveTime or related services may be required to file the affidavit to confirm their tobacco use status.

How to fill out DriveTime Tobacco Use Affidavit?

To fill out the DriveTime Tobacco Use Affidavit, individuals should provide their personal information, indicate whether they use tobacco products, and sign the form to certify that the information is true.

What is the purpose of DriveTime Tobacco Use Affidavit?

The purpose of the DriveTime Tobacco Use Affidavit is to ensure compliance with health regulations and company policies regarding tobacco use, which may impact workplace safety and insurance requirements.

What information must be reported on DriveTime Tobacco Use Affidavit?

The information that must be reported on the DriveTime Tobacco Use Affidavit includes the individual's name, contact details, tobacco usage status, and a signature affirming the accuracy of the provided information.