Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by entering the employer name in the designated field. This identifies your organization to which the form relates.
3. Next, input the location ID in the corresponding section to link the form with the proper office location.
4. Provide the full name of the individual whose eligibility status is being reported in the section labeled 'Name.' Ensure that this matches the official records.
5. Fill in the mailing address for the individual in the specified field, making sure to include complete information for accurate correspondence.
6. Enter the membership number assigned by the Division of Pensions and Benefits in the relevant field for identification purposes.
7. Input the social security number of the individual being reported. This protects against identity confusion and assists in processing the form.
8. Fill in the annual salary of the individual in the designated space. This figure is crucial in determining eligibility status.
9. Indicate the reason for the cessation of contributions to the DCRP by selecting one of the options provided, such as loss of eligibility or termination of employment, and supply the effective date.
10. If applicable, provide the reason for termination of employment in the corresponding section. This will clarify the situation further.
11. If the individual is on a leave of absence, mark the start and end dates of the leave in the specified fields and include the reason for the leave.
12. Finally, if the individual has returned from a leave of absence and resumed contributions, provide the effective date of this status change.
13. Don't forget to have the certifying officer sign the form in the signature section to validate the information submitted.
14. After completing all fields, users can save changes, download, print, or share the form as necessary.

Complete your DCRP Eligibility Status Change Verification Form online today.