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Get Payroll Deduction Form (for Non-State Of CT Employees) Use This Form To Establish Or Modify Payroll

Employee Questions? Call toll-free 1-888-799-CHET (1-888-799-2438) P.O. Box 150499, Hartford, CT 06115-0499 Visit www.aboutCHET.com Instructions Read the Disclosure Booklet and the Employee Checklist on the reverse side before completing this form. (A special note to State of Connecticut employees: STOP HERE. Use the State of Connecticut Employee Payroll Deduction Form, which is available online or by calling the Program. Do not use this form. ) Only non-State of Connecticut employees shou.

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