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MISSISSIPPI STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE PLAN Tobacco Use Attestation Form All sections of the form below must be completed in order for the form to be processed. Please print in blue

How to fill out tobacco attestation form

How to fill out a tobacco attestation form:

1. Begin by gathering all the necessary information such as your personal details, including your name, address, and contact information.
2. Read through the form carefully to understand the requirements and statements you must agree to. Pay close attention to any specific instructions or questions provided.
3. Provide accurate information regarding your tobacco use. If you are a tobacco user, be sure to indicate the frequency and type of tobacco product you use. If you are a non-tobacco user, indicate that as well.
4. Sign and date the form at the designated spaces to confirm your understanding and agreement with the provided statements. Make sure your signature is legible and matches the name you provided.

Who needs a tobacco attestation form:

1. Individuals applying for certain job positions or participating in specific programs may be required to fill out a tobacco attestation form. This form is often used by employers, organizations, or institutions to gather information regarding an individual's tobacco use.
2. Some companies and organizations have policies in place regarding the use of tobacco products. To ensure compliance with these policies, applicants or participants may be asked to complete a tobacco attestation form to confirm their tobacco use status.
3. It is important to note that the need for a tobacco attestation form may vary depending on the specific requirements and regulations of the employer or organization. It is advisable to consult the guidelines or instructions provided by the respective entity to determine if a tobacco attestation form is required.

For pdfFiller’s FAQs

What is tobacco attestation form?

Tobacco attestation form is a document used to certify compliance with tobacco regulations.

Who is required to file tobacco attestation form?

Tobacco retailers and distributors are required to file tobacco attestation form.

How to fill out tobacco attestation form?

Tobacco attestation form can be filled out online or downloaded and submitted through mail.

What is the purpose of tobacco attestation form?

The purpose of tobacco attestation form is to ensure compliance with tobacco regulations and to prevent illegal sales of tobacco products.

What information must be reported on tobacco attestation form?

Information such as business name, address, type of tobacco products sold, and confirmation of compliance with tobacco laws must be reported on tobacco attestation form.

When is the deadline to file tobacco attestation form in 2023?

The deadline to file tobacco attestation form in 2023 is July 1st.

What is the penalty for the late filing of tobacco attestation form?

The penalty for late filing of tobacco attestation form may include fines or suspension of tobacco sales license.

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