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Certification of Healthcare ProviderEmployee For Completion by Employee : This form must be completed in its entirety by your healthcare provider and returned to HR within 15 calendar days. Failure to
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How to Fill Out CHP - Employee:

01
Start by obtaining the CHP - Employee form from your employer or human resources department. This form is typically required for new employees or when there are changes in employment status.
02
Begin by entering your personal information in the designated fields. This may include your full name, date of birth, social security number, and contact information.
03
Provide your employment details, such as your job title, department, start date, and any other relevant information requested on the form.
04
Fill out the section pertaining to your tax withholding status. This requires indicating whether you are claiming any exemptions and specifying the amount of federal and state tax you would like withheld from your paycheck.
05
If you have any dependents, you might need to provide their information as well, including their names and social security numbers.
06
In case of emergency, provide the contact details of the person(s) to be notified in case of an emergency.
07
Read through the form carefully and sign and date it at the bottom, confirming that the information provided is accurate to the best of your knowledge.
08
Return the completed CHP - Employee form to the appropriate department or individual as instructed by your employer.

Who Needs CHP - Employee:

01
New Employees: Individuals who have recently been hired by a company or organization often need to fill out the CHP - Employee form as part of the onboarding process.
02
Existing Employees with Employment Changes: If there are any changes in an employee's job status, such as a promotion, transfer, or change in tax withholding, they may be required to complete a new CHP - Employee form.
03
Human Resources/Employer: The human resources department or employer needs the CHP - Employee form to maintain accurate and up-to-date employee records, comply with legal requirements, and ensure proper payroll administration.
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