Get Foster Child Certification Form (pdf) - Mn.gov

The Foster Child Certification Form is an essential document for employees seeking insurance coverage for their foster children. This guide will provide clear, step-by-step instructions to help users complete the form accurately and efficiently, ensuring that all necessary information is provided for approval.

Follow the steps to fill out the Foster Child Certification Form online:

1. Press the ‘Get Form’ button to obtain the Foster Child Certification Form and open it in your preferred PDF editor.
2. Begin by filling out the member information section. You will need to provide your last name, first name, middle initial, mailing address, city, state, zip code, home phone number, agency, and employee ID number.
3. In the foster child information section, fill out the child's last name, first name, middle initial, date of birth in mm/dd/yyyy format, and their social security number.
4. Indicate the child’s gender by selecting either male or female and confirm whether the child lives with you.
5. Answer the questions regarding the child’s eligibility for various programs, such as the DHS foster care program or federal/state health care programs.
6. Provide details on who is financially responsible for the child and if anyone else receives payments for their care.
7. Explain the circumstances under which the child has become your legal foster child and your expectation of the duration of this relationship.
8. Complete the certification section by signing and dating the form to confirm the accuracy of the information provided.
9. Once all sections are complete, you can save your changes. Consider downloading, printing, or sharing the form as needed to submit it.

Complete the Foster Child Certification Form online today and ensure your foster child receives the coverage they deserve.