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.

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:

1. Verify that the Employee Acknowledge checkbox is checked.
2. 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.

1. Select the destination.
2. 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.

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.

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.

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