Get University Of Michigan Benefits Office Declaration Of Tax Status For Other Qualified Adult 2019-2025

This guide provides a comprehensive overview of how to accurately fill out the University Of Michigan Benefits Office Declaration Of Tax Status For Other Qualified Adult. By following these steps, users can ensure they meet all necessary criteria and submit their form correctly online.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your faculty or staff member information. This includes your name (last, first, middle initial), UMID, home street address, city/state/zip, daytime phone, email address, and U.S. social security number if you do not have a UMID.
3. Fill in the Other Qualified Adult (OQA) information. Provide their name (last, first, middle initial) and date of birth.
4. In the declaration section, confirm that you have enrolled the Other Qualified Adult under your university health care coverage and that they meet the eligibility criteria, citing the requirements for being considered a dependent under the Internal Revenue Code (IRC) Section 152.
5. Select the appropriate box to declare whether your Other Qualified Adult qualifies as your IRC Section 152 dependent for the specified tax year. If applicable, provide the names and birth dates of their children.
6. Sign and date the certification section at the bottom of the form, confirming understanding of the eligibility criteria and obligations under penalty of perjury.
7. Make a copy of your completed and signed form for your records and proceed to submit the original to the University of Michigan Benefits Office as instructed.

Complete your form online now to ensure all necessary information is properly submitted.