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Print Reset Page 202 W. First Street, Suite 500 Los Angeles, CA 90012-4401 (800) 779-8328 TDD (888) 349-3996 Fax: (213) 687-4174 www.LACERS.org CERTIFICATION OF DEPENDENT OR SURVIVOR STATUS FOR HEALTH
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01
Gather the necessary information and documents. You will need personal details such as your name, address, and social security number, as well as the dependent's information such as their name, relationship to you, and social security number.
02
Carefully read the instructions provided with the certification form. Make sure you understand the requirements and any supporting documents that may be needed.
03
Begin filling out the form by providing your personal information in the designated fields. Double-check for accuracy and completeness.
04
Move on to the section where you provide the dependent's information. Fill out all the required fields, ensuring that you have the necessary supporting documents to verify their dependent status.
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If there are any additional sections or questions on the form, answer them accordingly.
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Review the completed form for any errors or missing information. Make any necessary edits before finalizing.
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Sign and date the certification of dependent or form, certifying that the information provided is true and accurate to the best of your knowledge.
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Submit the completed form to the appropriate party or organization as instructed.

Who needs certification of dependent or:

01
Individuals who have dependents and need to claim them for tax purposes may require a certification of dependent or.
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Employers may require employees to fill out a certification of dependent or to ensure accurate tax withholding.
03
Various institutions, such as insurance companies or government agencies, may request a certification of dependent or to determine eligibility for certain benefits or programs.
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Certification of dependent or refers to the process of verifying and declaring a dependent for tax or insurance purposes.
Anyone who is claiming a dependent on their taxes or insurance coverage may be required to file certification of dependent or.
To fill out certification of dependent or, one must provide information about the dependent's relationship to the filer, their age, and any other relevant details requested on the form.
The purpose of certification of dependent or is to verify the dependent status of individuals for tax or insurance purposes.
Information such as the dependent's name, date of birth, relationship to the filer, and other relevant details must be reported on certification of dependent or.
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