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Los Angeles Unified School District Benefits Administration REQUEST FOR CHANGE OF DEPENDENT STATUS SPECIAL ENROLLMENT DEPENDENTS UP TO AGE 26 ACTIVE EMPLOYEES SEPTEMBER 1 30, 2010 Employee Number
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To fill out a change of dep stat form, follow these steps:
01
Obtain the change of dep stat form from the appropriate department or organization. This form may be available online or in physical copies.
02
Fill in your personal information, such as your full name, contact information, and any identification numbers required. Make sure to provide accurate details to avoid any discrepancies.
03
Indicate the reason for the change of dep stat. This could be a change in your marital status, the birth or adoption of a child, or any other relevant circumstance. Specify the date when this change occurred.
04
If applicable, provide the details of your previous dependent status. This might include the names of dependents, their dates of birth, or any relevant legal documents.
05
Attach any supporting documentation required to validate the change of dep stat. This could include marriage certificates, birth certificates, or any other relevant legal documents. Ensure that you make copies of these documents for your records.
06
Review the completed form thoroughly to ensure accuracy and completeness. Double-check all the information provided and make any necessary corrections.
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Sign and date the form to confirm that the information provided is true and accurate. Depending on the requirements, you may need to have the form notarized or witnessed by a third party.
Who needs a change of dep stat? Individuals who experience changes in their marital status, have children through birth or adoption, or undergo any relevant life events may require a change of dep stat form. This form allows them to update their dependent status for various purposes, such as tax filings, insurance coverage, or any other organization-specific requirements. It is important to check with the relevant department or organization to determine if a change of dep stat form is necessary in your specific situation.
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