Office of Human Resources - Benefits Design & Management

Enrollment INSTRUCTIONS

RETIREMENT BENEFITS You have 30 DAYS from your eligibility date to enroll in the mandatory retirement program. New Employee Benefits Package
CLASSIFIED STAFF	ARIZONA STATE RETIREMENT (ASRS) Enrollment Form | Beneficiary Form Classified Staff Instructions
FACULTY ADMINISTRATORS AND ACADEMIC/SERVICE PROFESSIONALS	ARIZONA STATE RETIREMENT (ASRS) Enrollment Form | Beneficiary Form | Election of Retirement Option Form OR OPTIONAL RETIREMENT PLAN Declaration of Understanding Form | Election of Retirement Option Form Faculty, Academic & Service Professionals & Administrators Instructions
POLICE OFFICERS AND RECRUITS	PUBLIC SAFETY PERSONNEL RETIREMENT SYSEM (PSRS) Membership Form Public Safety Personnel Retirement System Online

HEALTH, LIFE & DISABILITY BENEFITS You have 31 DAYS from your eligibility date or a qualified life event to enroll you and your eligible dependents into the benefit program. New Employee Benefits Package New Employee Benefits Package for Postdoctoral Scholars   Add a Qualified Domestic Partner Add an Older Child or a Qualified Domestic Partner's Child
BENEFITS ENROLLMENT PACKETS	Standard Benefits Enrollment Packet Enrollment Packet—with Domestic Partner Enrollment Packet— with Domestic Partner's Child Enrollment Packet—with Older Child Declaration For Change
FLEXIBLE SPENDING ACCOUNTS FORMS	Enrollment Form Change Form Direct Deposit/Email Notification

INSTRUCTIONS
How to Add a Qualified Domestic Partner

Enrollment Forms These packets includethe basic enrollment form, plus worksheets and certifications documents. NOTE: You must fill out a certification form for each child or domestic partner's child. PACKETS With Domestic Partner With Domestic Partner's Child With Older Child OTHER FORMS Basic Benefits Enrollment Form Qualified Domestic Partner Affidavit Domestic Partner's Child Declaration of Tax Status Older Child Declaration of Tax Status Worksheet for Determining Support Dissolution of Domestic Partnership RETIREMENT FORMS ASRS ASRS Enrollment Form ASRS Beneficiary Form Election of Retirement Option Form. Optional Retirement Plan Declaration of Understanding Form Election of Retirement Option

Review the Declaration of Tax Status Form to determine whether your qualified domestic partner fulfills the requirements to be a tax dependent.

If you are unsure whether your domestic partner meets the support requirement for dependent status, you may confirm eligibility by using the optional Worksheet for Determining Support form.  Keep the worksheet for your personal records.  You do not need to return the worksheet with the other forms.

Complete--and have notarized--a Domestic Partner Affidavit.  

In addition to the Affidavit, you MUST provide at least three of the following documents to show that each person is financially interdependent in at least three of the following ways:

• Having a joint mortgage, joint property tax identification or joint tenancy on a residential lease;
• Holding one or more credit or bank accounts jointly, such as a checking account in both names;
• Assuming joint liabilities;
• Having joint ownership of significant property, such as real estate, a  vehicle or a boat;
• Naming the partner as beneficiary on the employee’s life insurance, under the employee’s will or employee’s retirement annuities and being named by the partner as beneficiary of the partner’s life insurance, under the partner’s will or the partner’s retirement annuities;
• Each agreeing in writing to assume financial responsibility for the welfare of the other (i.e. durable power of attorney);
• Other proof of financial interdependence as approved by the Director;

Complete Domestic Partner Declaration of Tax Status form.

Complete the enrollment form.

Sign and date, and print your Employee ID Number on the Declaration of Tax Status for a Domestic Partner form.

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INSTRUCTIONS
How to Add an Older Child or
a Qualified Domestic Partner's Child

Complete and return the required form(s).  You must complete a separate Declaration of Tax Status form
for each Older Child or Qualified Domestic Partner's Child you are adding:

• Declaration of Tax Status form
• Benefits Enrollment Form

Review the Declaration of Tax Status to determine whether the child fulfills the requirements to be a tax dependent.

If you are unsure whether the child meets the support requirement for dependent status,use theoptional Worksheet for Determining Support form to confirm eligibility.

To complete the optional Worksheet for Determining Support, you will need to know the child’s:

• Gross monthly income, if any,
• Mortgage/rental payment, if any,
• Monthly expenses for items such as food, utilities, repairs, clothing, education, medical, travel, etc.

Keep the worksheet for your personal records.  You do not need to return the worksheet.

Sign and date, and print your Employee ID Number on the Declaration of Tax Status form.

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