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Updated: 7/2018UNIVERSITY OF ROCHESTER Dependent Information Change Request Form Please Print Clearly Employee Information: Name: ___ Employee ID#: ___ Phone Number: ___ Email: ___Dependent Information:

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How to fill out dependent information change request

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Gather required forms and documents

02

Complete the dependent information change request form accurately

03

Provide any necessary supporting documentation, such as marriage certificate or birth certificate

04

Submit the completed form and documents to the appropriate department or HR representative

05

Follow up with the department or HR representative to ensure the request is processed

Who needs dependent information change request?

01

Employees who need to update or change the information of their dependents with the company

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What is dependent information change request?

A dependent information change request is a form or process used to update or modify information related to dependents, such as dependents' names, birth dates, or relationship status.

Who is required to file dependent information change request?

The primary policyholder or account holder is typically required to file a dependent information change request.

How to fill out dependent information change request?

Dependent information change requests can usually be filled out online, through customer service, or by submitting a physical form with the updated information.

What is the purpose of dependent information change request?

The purpose of a dependent information change request is to ensure that accurate and up-to-date information is maintained regarding dependents for insurance, benefits, or other purposes.

What information must be reported on dependent information change request?

Information such as dependent's name, date of birth, social security number, relationship to policyholder, and any changes to existing information may need to be reported on a dependent information change request.

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