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State of New York Department of Civil Service Albany, NY 12239 EMPLOYEE BENEFITS DIVISION Statement of Disability Dependent 19 Years of Age or Older PS-451 (5/06) PART A (To Be Completed By Enrollee.

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How to fill out the Ps 451 online

The Ps 451 is a crucial document for enrollees requesting continuation of health insurance coverage for their dependents who are disabled and unable to support themselves. This guide provides a clear and supportive step-by-step approach to help you navigate the form effectively.

Follow the steps to complete the Ps 451 online

  1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
  2. Complete Part A of the form, which requires the enrollee's name, health insurance ID number, home address, and request for continuation of NYSHIP coverage for the dependent. Ensure you check the relationship of the dependent.
  3. In Part B, your employing agency will fill in the required information including effective date of insurance and verify the dependent’s eligibility. Ensure they complete this part before moving on.
  4. Leave Part C blank. This section will need to be completed by the health maintenance organization or United Healthcare after receiving input from the attending physician.
  5. After completing all parts, either the enrollee or the attending physician should mail the completed form to the appropriate carrier, either United Healthcare or directly to the HMO.
  6. Ensure to keep a copy of the completed form for your records and any additional documentation needed.

Start filling out the Ps 451 online today to ensure your dependent's health insurance coverage continues seamlessly.

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That I am _______________ of ______________, Son/D/W/B of ___________________. That my _______________(Relationship with Applicant) __________________(Name) expired on _____________(Date of Death) at ___________(Name of place). That I am swearing this Affidavit to establish relationship with my ______________.

That I am _______________ of ______________, Son/D/W/B of ___________________. That my _______________(Relationship with Applicant) __________________(Name) expired on _____________(Date of Death) at ___________(Name of place). That I am swearing this Affidavit to establish relationship with my ______________.

Here's how you can do it in just a few steps: Open your document in . ... Click on the "More" button. ... Select "Attach Affidavit" ... Choose your affidavit file. ... Attach your affidavit to the document. ... Make any necessary changes. ... Save and send your document.

Proof of relationship can include joint financial documents (bank statements, joint leases, etc.), photographs of the couple together, affidavits from friends and family attesting to the authenticity of the relationship, joint utility bills, joint insurance policies, travel itineraries, and any other relevant ...

include all relevant facts • be written in the first person using an active voice • use the correct naming conventions • use the child or family's own words • use descriptions of what you saw and heard rather than conclusions • provide context to situations which could be misinterpreted • date all records and include ...

Example: I, Jane Smith, swear that the information in my sworn statement is truthful to the best of my knowledge and understanding. Your statement of truth must be in the first person and you need to identify yourself in it. Keep it short and sweet.

How to write an Affidavit of Identity? Your full, legal name. Your date of birth. Your address. An acceptable form of government ID. Your signature. The signature and seal of a notary public.

An Affidavit of Relationship (AOR) is a form used for reunification of refugees and asylees with close relatives living outside of the U.S. In documenting family relationships, the AOR gives eligible applicants access to the US Refugee Program.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232