Required Verification Documents

Required Verification Documents

Dependent Category Documents Required to Complete Dependent Verification

Legal Marriage (Opposite Sex or

Same Sex) Marriages in 2015:

Send the Legal Marriage Certificate only.

Option 1 2014 1040 Tax Form

Send a copy of your legal marriage certificate AND

Send a copy of the first page of your 1040 federal income tax return showing a married filing status.

• If you file separately, send the first page of both your and your spouse’s federal income tax return.

• Do not send W-2s.

Option 2

Legal Marriage Certificate AND Two Joint Financial Documents

Send a copy of your legal marriage certificate

AND

Send copies of two current joint financial documents showing you and your spouse at the same address.

• Examples of joint financial documents include: mortgage statement, joint homeowners or renters insurance declaration page, auto insurance policy declaration page, auto loan, personal loan, credit card, and utility bill (except mobile phone bills).

• Documents must be dated within the past 60 days.

• Documents must be from two different organizations (for example, do not send a credit card statement and auto loan statement from the same bank).

Legal Separation

Legal Separation Agreement

• Send a COPY of your Legal Separation Agreement on file with the court.

If a Legal Separation Agreement is not available, please submit the documents for Legal Marriage, along with a letter of explanation.

Divorce Final Divorce Decree

• Send a COPY of your Final Divorce Decree on file with the court.

Terminated Domestic Partnership

Final Affidavit of Terminated Domestic Partnership

• Send a COPY of your Final Affidavit of Terminated Domestic Partnership.

If this document is not available, please write a letter of explanation, or other documentation that verifies your relationship is terminated.

& &

Dependent Category Documents Required to Complete Dependent Verification

Common Law Marriage

Option 1 2014 1040 Tax Form

Send a copy of the first page of your 1040 federal income tax return showing a married filing status.

• If you file separately, send the first page of both your and your spouse’s federal income tax return.

• Do not send W-2s.

Option 2

Declaration of Informal Marriage Certificate/

State Affidavit of Common Law Marriage AND Two Joint Financial Documents

Send a copy of your Declaration of Informal Marriage Certificate or your State Affidavit of Common Law Marriage.

AND

Send copies of two current joint financial documents showing you and your spouse at the same address.

• Examples of joint financial documents include:

mortgage statement, joint homeowners or renters insurance declaration page, auto insurance policy declaration page, auto loan, personal loan, credit card, and utility bill (except mobile phone bills).

• Documents must be dated within the past 60 days.

• Documents must be from two different

organizations (for example, do not send a credit card statement and auto loan statement from the same bank).

Domestic Partnership

Affidavit of Same-Sex Domestic Partnership AND Two Joint Financial Documents

Send a COPY of your Affidavit of Same-Sex Domestic Partnership on file with Wake Forest University (or a new affidavit, if you do not have the original).

AND

Send copies of two current joint financial documents showing you and your spouse at the same address.

• Examples of joint financial documents include: mortgage statement, joint homeowners or renters insurance declaration page, auto insurance policy declaration page, auto loan, personal loan, credit card, and utility bill (except mobile phone bills).

• Documents must be dated within the past 60 days.

• Documents must be from two different organizations (for example, do not send a credit card statement and auto loan statement from the same bank).

&

&

Dependent Category Black out any Social Security numbers, financial figures, or account numbers on documents you submit.

Biological Child

Birth Certificate is required for each biological child 6 months old or older. The birth certificate must be issued by the state, county, or other government body AND list the employee as a parent. Short form birth certificates, which only list the name and date of birth of the child, will not be accepted.

Note: a short form birth certificate, which only lists the name of the child and the child’s date and place of birth, is not acceptable for this dependent verification.

OR

Hospital Letter—If birth certificate is not available for a child under 6 months old, submit birth documentation on hospital letterhead indicating the birth date of the child or children, AND the names of the parent(s).

OR

Court Order—If birth certificate is not available, a court order (such as a Qualified Medical Child Support Order, National Medical Support Notice or other court document) may be substituted.

Adopted Child

Placement Papers OR Adoption Agreement OR Birth Certificate— Send a copy of the placement papers for a child placed with you for adoption (initial stage), or Official Court Adoption Agreement for an adopted child (mid-stage), or legal birth certificate (final stage).

OR

Court Order—If birth certificate is not available, a court order (such as a Qualified Medical Child Support Order, National Medical Support Notice or other court document) may be substituted.

Stepchild

Child’s Birth Certificate— Send a copy of the child’s government-issued birth certificate showing that the child’s parent is the employee’s spouse.

Note: a short form birth certificate, which only lists the name of the child and the child’s date and place of birth, is not acceptable for this dependent verification.

AND

Legal Marriage or Common Law Marriage Documents—See notes in the Legal Marriage or Common Law Marriage sections for information about submitting these documents.

Child of a Domestic Partnership

Child’s Birth Certificate— Send a copy of the child’s government-issued birth certificate showing that the child’s parent is the employee’s spouse.

Note: a short form birth certificate, which only lists the name of the child and the child’s date and place of birth, is not acceptable for this dependent verification.

AND

Domestic Partner Documents—See notes in the Domestic Partner section for information about submitting these documents.

Foster Child Placement Papers— Send a copy of the placement papers from the agency or government office.

The placement papers must name the faculty or staff member as a foster parent.

Other Child Type For a grandchild, niece/nephew, brother/sister, or other child type, send guardianship papers.

Guardianship Papers—Court papers demonstrating legal guardianship. Document must include

the name(s) of the person(s) designated as the legal guardian(s).

Key to Document Status on Website

Banner Displayed by Dependent’s Name What Banner Means

You must submit verification documents for this dependent. Click on “Click Here for Documents”

to read the specific document requirements for this dependent.

This dependent is not eligible to continue coverage.

Refer to the reason given for more explanation.

The documents submitted for this dependent are not complete, or something is missing. Please scroll down to the Comments section to read a message from the auditor to see what is missing. You can also call 1-866-691-6551 to speak with an auditor regarding the incomplete submission.

This dependent has been verified, and the dependent

eligibility process requirements have been met. No

further action is required for this dependent.

Document Submission Form

TO: Dependent Eligibility Center

Fax Number: 1-866-710-2702 Email: DOCUMENTS@MYDEPENDENTS.COM

Faculty or Staff Member’s Name: _____________________________________________________________

Call-Back Phone Number: ___________________________________________ Total Pages Sent: ________

Contents Documents Submitted

□ Document 1 ___________________________________________________________________________

□ Document 2 ___________________________________________________________________________

□ Document 3 ___________________________________________________________________________

□ Document 4 ___________________________________________________________________________

□ Document 5 ___________________________________________________________________________

□ Document 6 ___________________________________________________________________________

□ Document 7 ___________________________________________________________________________

□ Document 8 ___________________________________________________________________________

Important Notices

• Save your document submission, including your fax confirmation sheet, in a safe place until you log back into your audit website or call to verify that your dependents are complete.

• You will receive a call regarding your document submission ONLY if anything is missing or incomplete.

• Log back in to your verification website 3 business days after faxing or e-mailing your documents (7 business days if mailed) to check your status.

• When a dependent is complete and eligible, you will see a green “COMPLETE” banner. If a dependent shows

any other banner, please review the notes and/or contact us at 1-866-691-6551 for more information.