Get the Tobacco-Free Discount Benefit Affidavit - myhr cuyahogacounty
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Cuyahoga County Executive Edward FitzGerald2014 TOBACCO FREE INCENTIVE PROGRAM EMPLOYEE AFFIDAVIT Pursuant to Cuyahoga Counties introduction of a Wellness Program for Tobacco Cessation, employees*
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How to fill out tobacco- discount benefit affidavit
How to fill out tobacco- discount benefit affidavit
01
Obtain the tobacco discount benefit affidavit form from your employer or benefits administrator.
02
Fill in your personal information accurately, including your full name, address, and Social Security number.
03
Indicate whether you are a tobacco user or non-tobacco user as requested on the form.
04
Sign and date the affidavit, certifying that all the information provided is true and accurate.
05
Submit the completed form to your employer or benefits administrator for processing.
Who needs tobacco- discount benefit affidavit?
01
Employees who are eligible for tobacco discount benefits offered by their employer.
02
Individuals who are required to prove their tobacco usage status for insurance or health benefit purposes.
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What is tobacco- discount benefit affidavit?
Tobacco discount benefit affidavit is a form that tobacco retailers must fill out to report any discounts or benefits received from tobacco manufacturers or distributors.
Who is required to file tobacco- discount benefit affidavit?
All tobacco retailers who receive discounts or benefits from tobacco manufacturers or distributors are required to file the tobacco- discount benefit affidavit.
How to fill out tobacco- discount benefit affidavit?
To fill out the tobacco- discount benefit affidavit, retailers must provide information about the discounts or benefits received, the names of the manufacturers or distributors, and other relevant details.
What is the purpose of tobacco- discount benefit affidavit?
The purpose of tobacco- discount benefit affidavit is to ensure transparency in the tobacco retail industry and to prevent illicit activities such as tax evasion.
What information must be reported on tobacco- discount benefit affidavit?
Retailers must report any discounts, benefits, or incentives received from tobacco manufacturers or distributors, including the names of the companies and the amounts received.
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