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.
| Form | Description |
|---|---|
| Affidavit of Parent Child Relationship |
This form should be printed, completed, and submitted in person to the campus benefits office for a 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 should be printed, completed, and submitted 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.
The forms can be filled out by either completing a self-service event (Life event, for example) or by a Benefits Officer.
| Campus Type | Who completes the online form |
Who can print populated forms |
|---|---|---|
|
Full self-service |
Employee |
Both |
|
View-only self-service |
Benefits officer |
Both |
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.
Step 4: If you are printing the Dependent Re-Verification form:
- Check the Employee Acknowledgement.
- Click Print .PDF
Dependent Re-verification Form only.
Step 5: Click the printer icon to save the file locally as a PDF file or send the file to a printer.
Step 6: Select the desired print option.
End of Article
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