Overview
This job aid shows benefits officers how to manage employee dependent re-verification forms.
- Print dependent re-verification affidavit
- Confirm Receive date for the re-verification affidavit
- Dependent Re-verification History page
Background
- CalPERS requires employees to re-verify their dependents who receive benefits at least once every three years.
- Employees can complete, print, and submit the form online.
- Event class and event due date fields are pre-populated.
- Benefits officers print the form, enter a received date.
- After the form is received, the form then moves to the Dependent Re-verification History page.
Print dependent re-verification affidavit
Step 1: Open the CSU Benefits Administrator tile.

Step 2: Navigate to CSU Dependent Verification.
- Employee/Dependent Information > CSU Dependent Verification
Step 3: Enter search criteria and then click Search.
- The search returns employees who have submitted the Dependent Re-verification Affidavit

- The Permitting Event Code and Event Dates are pre-populated.

The Permitting Event Code and Event Dates are pre-populated.
Step 4: Click Print PDF.
- The electronic form opens.

Step 5: On the electronic form:
- Verify that the Employee Acknowledge checkbox is checked.
- If the box is checked, click Print PDF
- Scroll down to find the Employee Acknowledge check box.
- The Employee Acknowledge check box must be checked. Do not print without this acknowledgment.
- The form opens as a PDF document in the browser.

Step 6: Click the print button on the browser PDF toolbar. ,

Step 7: Print the form.
- Select the destination.
- Click Save or Print.
- If you select a printer, the Save button changes to Print.

Step 8: Close the tab with the PDF version of the form.

Step 9: Click Exit.

Confirm Receive date for the re-verification affidavit
When you have received the form you can confirm the received date. After you save this information, the dependent is no longer listed on this page.
Step 1: Enter the Received Date.

Step 2: Click Save.
- The form is moved to the Dependent Re-verification History page. If you click Search again, the page does not display this row.

Dependent Re-verification History page
If the PSR is not complete, you can edit the permitting code, event date, and received date from the Dependent Re-verification History page.
Step 1: Open the CSU Benefits Administrator tile.

Step 2: Navigate to CSU Dependent Ver History.
- Employee/Dependent Information > CSU Dependent Ver History
Step 3: Enter search criteria and then click Search.

Step 4 Optional: Click the Correction check box to edit any of these fields:
- Permitting Event Code
- Event Date
- Received Date

Step 5 Optional: Click Print PDF to print the form.
- After you click Print PDF, the printing steps are the same as on the CSU Dependent Verification page.

End of Article
0 Comments
Add your comment