Print Dependent Verification Forms - Employee | Employee Self-Service | CHRS Knowledge Base

Overview

This job aid shows employees how to print dependent verification forms from the Dependent and Beneficiary Coverage Summary page.

Affidavit of Parent-Child Relationship (APCR)
Domestic Partner Dependent Certification (DPDC)
Dependent Re-verification Affidavit

Electronic forms

This table provides information about forms that you can print from eBenefits. These forms are pre-populated from system data to save you time.

You can print out the Affidavit of Parent Child Relationship form and the Domestic Partner Affidavit form only if you have filled out the form by completing a Life Event, an Open Enrollment event, or a New Hire event.

You cannot generate a Affidavit of Parent Child Relationship form or the Domestic Partner Affidavit form for the dependent re-verification process by using CHRS at this time.

Form	Description
Affidavit of Parent Child Relationship	This form is printed and completed when you add a Recognized Child dependent via a eBenefits Self Service transaction. Submit the form via MoveIT or in person to the campus benefits office for a Recognized Child dependent you wish to enroll in benefits who is not your adopted, step, or recognized natural child. You are required to substantiate a financial responsibility upon initial enrollment and annually thereafter, up to the child reaching age 26. You must submit a separate Affidavit of Parent Child Relationship for each PCR dependent.
Domestic Partner Affidavit	This form is printed and completed when you add a Domestic Partner Adult dependent via a eBenefits Self Service transaction. Submit the form via MoveIT or in person to the campus benefits office when a State of California Declaration of Domestic Partnership is not available. The form must be submitted in order for your registered domestic partner to be enrolled in benefits.
Dependent Re-verification affidavit	This form should be printed, completed and submitted in person to the campus benefits office only when you have been notified by CalPERS of the need to verify your dependent(s)’ eligibility for benefits. Dependents include your spouse, registered domestic partner, natural born child, adopted child, stepchild, or the child of your registered domestic partner. This dependent verification of benefits eligibility process is conducted once every three years for most dependents.

Employee Self-Service differences

The actions you can take with your forms depends on how your campus implements eBenefits.

Campus Type	Who completes the online form	Who can print populated forms
Full self-service	Employee	Employees and Benefits Officers
View-only self-service* (*view only ESS users can only generate the Dependent Re-Verification form)	Employee	Employees and Benefits Officers

Print APCR and DPDC forms

Use this procedure to print the following forms:

Affidavit of Parent-Child Relationship (APCR)
Domestic Partner Dependent Certification (DPDC)
Dependent Re-verification Affidavit

Step 1: On the Employee Self Service Homepage, click the CSU Benefits Summary Tile.

If you are on a different homepage, select the Employee Self Service Homepage from the Homepage menu.

Step 2: Click Dependent Coverage in the navigation pane.

Step 3: Click one of the three available forms to open it.

Note that you can only print out the Affidavit of Parent Child Relationship form and the Domestic Partner Affidavit form if you have populated the form (filled out the form) by completing an eBenefits Employee Self Service event, such as a Life Event, an Open Enrollment event, or a New Hire event.

You cannot generate a Affidavit of Parent Child Relationship form or the Domestic Partner Affidavit form for the dependent re-verification process.