Get Dependency Application.doc - Laborcommission Utah

This guide provides clear instructions for users on how to effectively fill out the Dependency Application for continued benefits from the Utah Labor Commission. Follow the steps detailed below to ensure a smooth application process.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the Dependency Application document and open it in your preferred editor.
2. Begin by entering the Utah Labor Commission case number at the top of the form. If you do not have a case number yet, you may leave this section blank.
3. Fill in the decedent's full name in the designated field, ensuring that the spelling is accurate.
4. Identify your relationship to the minor child(ren) listed on the form. This relationship should reflect your legal status (e.g., parent, guardian).
5. Complete the fields for each of the decedent's minor child(ren) currently residing with you. Fill in their names, dates of birth, expected high school graduation dates, and total monthly Social Security death benefits received.
6. If applicable, list the names of any decedent's minor child(ren) who are not living with you and attach a separate sheet explaining the circumstances.
7. For the 'Application for Surviving Spouse Continued Dependency' section, fill in your full name and mailing address, and provide your daytime telephone number.
8. Sign and date the form at the bottom of the 'Application for Surviving Spouse Continued Dependency' section.
9. Complete the 'Application for Continued Dependency of Other Adult Dependent(s)' section by providing the requested information just as in the previous sections.
10. Sign and date the application form at the bottom of this section.
11. Finally, review all filled information for accuracy. You may then save your changes, download, print, or share the completed form as necessary.

Complete your application online to ensure timely processing of continued dependency benefits.