Follow the steps to fill out the form accurately.

1. Press the ‘Get Form’ button to acquire the form and open it for editing.
2. Begin by providing your HCA Facility Name at the top of the form. This identifies your workplace and helps process your request correctly.
3. Input your HCA 3-4 User I.D., which is a required field, ensuring you are recognized in the system.
4. Enter the last four digits of your social security number. This field is optional but may help in processing your request if needed.
5. Complete the section labeled 'My Information' by filling in your first name, middle initial (M.I.), last name, title, home phone number, work phone number, home street address, city, state, title/position, email, and ZIP code. This information is crucial for correct communication and processing.
6. For the payroll deduction change, indicate the current amount being deducted. Specify how much you would like to change this to for both The Hope Fund and United Way sections as applicable, ensuring to fill out 'per paycheck' for clarity.
7. Read the acknowledgment statement about the continuation of deductions until a change is submitted. This informs you of the policy regarding payroll deductions.
8. If requesting to stop your payroll deduction, indicate the amount currently being deducted for The Hope Fund and United Way. Confirm that you wish to stop the deductions.
9. Acknowledge the processing time by understanding it may take approximately one month for the change or stop to occur.
10. For faster processing, consider editing your donation online, as noted in the instructions.
11. Sign and date the form to validate your request. This step is important as it confirms your authorization.
12. Fax your completed form to HCA Community Relations at 877-687-3968 for final submission.

Complete the Change/Stop Payroll Deduction Form online today to manage your contributions effectively.