STEP 2:For each dependent type you will find the eligibility requirements and a list of document options required to verify that particular dependent type. STEP 3:Once you have matched your dependents to dependent types, gather all the necessary documents and submit them to the Aon Hewitt Dependent Verification Center by: Online Upload: www ...The yourdependentverification com plan in enrollment vendor denies your individual who want to dispense no involvement with regard to yourdependentverification com plan smart info. Describe automated approval beforeyou incur in nursing facility charge, a po prvem, as a claim has not be as you must be written request.Take advantage of internal communication. Internal communication is the best approach to prepare employees for a dependent eligibility verification for a variety of reasons. Employees trust communications from their employer, which is very important when asking for personal documentation. Use internal communications and clear, simple messaging.Site Registration - Step 1. Please enter the following information in order to register for access to this site. (Please enter your Audit ID exactly as it appears in your Dependent Eligibility Verification packet.) * Required * Please enter a valid date of birth. (Enter the date in "MM/DD/YYYY" format. For example, January 5, 1970 should be ...Goto Audit. Check-In Issue. Check-Out Next. Instructions: Please enter the reason this scan is being rejected: Reject Reason: -Select-Blank PagesIllegible / Difficult to ReadNot Properly ScannedSubscriber or Dependent Not FoundMultiple SubscribersDocument in Foreign LanguageOther. Scan successfully marked as rejected.Consova is a Human Resources firm specializing in the dependent verification process. They have conducted similar initiatives in Fortune 500 companies and governmental organizations. A comprehensive Employee Knowledge Center to help you through the dependent verification process.Penalties could be as much as $1,000 per day. Covering ineligible dependents can be costly. Performing a dependent verification audit helps employers cut down on healthcare spending by identifying ineligible dependents that a business no longer need to cover. Even if a small amount of ineligible dependents are listed on the plan, …com/plan-smart-info, or You can contact the Dependent Verification Center by phone at 866-272-7174, or by fax at 877-965-9555 Representatives are available Monday - Friday from 8 a.m. to 8 p.m. Eastern Time. What Is Dependent Verification? Dependent Eligibility Verification is the process used to verify that all dependents enrolled in a group ...DEPENDENT VERIFICATION AFFIDAVIT INSTRUCTIONS The City of Scottsdale performs an annual dependent eligibility review for the medical and dental plans offered to employees (collectively "Plan"). Please use this DEPENDENT VERIFICATION AFFIDAVIT to list the individuals you currently cover or wish to cover under the Plan, as your dependents.Title: frm_rpt_pdf.aspx Author: AH0124901 Created Date: 3/14/2017 2:51:41 PMThere are a variety of reasons companies choose to verify the eligibility of dependents. Reduce future dependent health care costs for you, the employee. Improve employee understanding of health care costs and each employee's own responsibility for controlling these costs. Reduce compliance risk under Sarbanes-Oxley, ERISA and DOL guidelines.Dependent verification documentation, and the Dependent Verification for Health/Dental/ Dependent Life Coverage Form must be returned to the Benefits Office within 30-days of your date of hire. All documentation should be returned to the following address: Harford County Public Schools Attn: Human Resources, Benefits Office 102 S. Hickory AvenueDependent Eligibility Verification (DEV) is the process of re-verifying the eligibility of your spouse, domestic partner, children, stepchildren, and domestic partner children (dependents) enrolled in health and/or dental benefits. To ensure only eligible dependents are enrolled in employer-sponsored health benefits, Government Code section ...How can a plan prevent ineligible dependents from being listed on the plan? Plans should request documentation when a new dependent is added (e.g., birth or marriage certificates) and when a dependent is removed (e.g., divorce decree). Plans should also confirm dependent eligibility at open enrollment time, and can ask for verifying documentation.You can use this site to access information about your benefit plans, enroll in your benefits and manage ongoing family status changes. We have enhanced our security protocols. You will need to register as a new user. Click the "First time user" link to get started. If you have already registered as a new user, simply login using the email ...STEP 1:Review the list of the dependents you have enrolled and match each of them to a dependent type listed in the “Eligibility Rules and Documentation Required” section. STEP 2:For each dependent type you will find the eligibility requirements and a list of document options required to verify that particular dependent type.Understanding dependent verification audits. A dependent verification audit is a methodical examination of the eligibility of dependents enrolled in an organization’s group health plan. Dependents typically include spouses, children, and sometimes other family members who may be eligible for health insurance, dental coverage, and other ...Effective, easy solutions to eliminate ineligible dependents. Our flexible solutions for initial and ongoing dependent verifications ensure that the verification process is designed to meet the specific needs of your organization, while …You can mail copies (not originals) of your required documents to PEBB along with your Dependent Eligibility Worksheet to 500 Summer Street NE, E-89, Salem, OR 97301-1063 Attn: Dependent Eligibility Review Team. 2. You can fax copies of your required documents, along with your Dependent Eligibility Worksheet, to our fax number at 503-373-1654. 3.Below is a list of all dependent eligibility documentation requirements for health benefits coverage for dependents. ... Disabled status for any child still requires current medical certification from the health plan in addition to ... Dependent_Verification.docx 9/2015 :dependent verification center p.o. box 1506 lincolnshire, il 60069-1506 return service requested 0000-1-1 hae2 10855237 01-07-2019 time sensitive materials enclosedDependent verification. Our rigorous dependent verification audit process makes sure you aren't paying extra. ADP ® has saved clients over $500 million as a result of dependent verification audits. Source: ADP® data, collected since inception 20 years ago. Without a thorough process for auditing benefits enrollment, you could end up paying ...July 18, 2023 0. www.yourdependentverification.com-smart-info/ is a website that offers smart information and verification services for dependents. It provides a convenient platform for individuals to verify their dependent status and access important information related to their dependents. Upon visiting the website, users can navigate through ...Dependent Verification Center P.O. Box 1403 Lincolnshire, IL 60069-1403. Overnight deliveries/packages only (anything that can't be sent to a post office box) Dependent Verification Center 100 Half Day Rd. Lincolnshire, IL 60069-1403. Employees Retirement System of Texas. 200 East 18th StreetIn a real-life scenario, an employer whose plan provides coverage for 1,000 dependents at a cost of $2,000 per year per dependent could save $200,000 per year by eliminating that unnecessary coverage.In today’s fast-paced digital world, technology has become an integral part of education. One such technological innovation that has gained popularity in classrooms is the smart bo...Dependent Verification Worksheet 2023-2024. Your Free Application for Federal Student Aid (FAFSA) has been selected by the U.S. Department of Education for a process called "Verification.". According to Federal Student Aid program rules (34 CFR, Part 668) the school must request, review, and compare your 2021 financial documents with the ...Secure Fax:1-855-769-5781. Mail: Claims and Appeals Management, P.O. Box 1434, Lincolnshire, IL 60069-1434 When faxing your information, do not include a cover sheet. Only fax this form, followed by any documentation. Acknowledgment and Signature. By my signature below, I formally file an appeal for reinstatement of coverage of the …Why you should conduct a dependent eligibility audit Save your company money. If you choose to conduct a dependent eligibility audit, you could bring significant savings to your company. When employers have performed a dependent eligibility audit with WEX, they've seen savings of $3,000 to $5,000 per plan member, per year. Maintain complianceDependent Verification Documentation. When enrolling dependents in your medical and/or dental coverage, you are required to provide documentation that proves a dependent’s relationship to you. Per Washington State Health Care Authority (HCA) policy, only certain types of documents qualify as valid “dependent verification.”.Yes, typically, you will need to pay extra premiums to include dependents in your health insurance coverage. The cost of adding dependents, such as a spouse or children, to a health insurance plan generally increases the overall premium. However, the specific amount of the increase depends on the insurance plan and provider.What you get. Tax return or tax account transcript types delivered by mail. Transcripts arrive in 5 to 10 calendar days at the address we have on file for you. Get transcript by mail. You can also request a transcript by mail by calling our automated phone transcript service at 800-908-9946. Visit our Get Transcript frequently asked questions ...Infographic: Simplifying your dependent eligibility verification audit. Ready to save on healthcare costs with dependent eligibility verification, but concerned about disrupting your people? We’re here to help. With the right approach, you can save significant health plan dollars and make the process simple and unintimidating for your people.to select your benefits, including completing your Dependent Verification Process first, in order to add your dependent(s) to your plan(s). You must send by email to [email protected], with the required Dependent Verification document(s), as noted in the Dependent Verification Chart at the end of this FAQ,Please enter your Plan-Smart password to view this report:Alight Plan-Smart is the leader in dependent eligibility audit solutions. Keywords: employee benefits, benefits enrollment, dependent eligibility audit, plan smart, Dependent Eligibility Verification, benefit costs, www.yourdependentverification.com -smart-info, yourdependentverification -plan-smart-info. https://plan-smart.com.Confirming coverage - When the school needs confirmation of a dependent's coverage, the plan member can contact our Client Care Center at 1-800-361-6212. Additional benefits cards for dependents Plan members can print personalized emergency travel and Pay-direct drug cards through mysunlife.ca or access them through the my Sun Life mobile app .SDSURF › Home (Human Resources) › Benefits › Health Plans › List of Documents You May Use to Prove Dependent Eligibility. List of Documents You May Use to Prove Dependent Eligibility. You need to provide a COPY of only one document type under the appropriate "proof" category.. Proof of Marital Status. Your most recent Tax Return: Federal or State, page one only; financial information ...The website is designed to streamline the verification process and ensure accuracy in benefits administration. The website is associated with the network IP addresses 35.171.65.198, 35.171.194.67 and 54.87.172.116.About Plan-Smart Effective, easy solutions to eliminate ineligible dependents. Our flexible solutions for initial and ongoing dependent verifications ensure that the verification process is designed to meet the specific needs of your organization, while minimizing your HR team's time commitment.Dependent verification. Our rigorous dependent verification audit process makes sure you aren't paying extra. ADP ® has saved clients over $500 million as a result of dependent verification audits. Source: ADP® data, collected since inception 20 years ago. Without a thorough process for auditing benefits enrollment, you could end up paying ...Please enter your Plan-Smart password to view this report:Edit yourdependentverification plan smart info form. Add and replace text, insert new objects, rearrange pages, add watermarks and page numbers, and more. ... The purpose of your dependent verification is to ensure that only eligible individuals are claimed as dependents on tax returns, preventing tax fraud and inaccuracies.Use our 5 employee communication tips to have a smooth dependent verification audit & reassure your company that it's a common business best practice. Read more. PRODUCT. 3 2. Now Available. The Source Personalize+. Learn More. Product. Benefits Platform.I received a letter today from UPS asking me to send proof of verification of all my dependents for my health care. I still have my health insurance with UPS although it certainly isn't as good as it was before the last contract. Anyway they want me to send a copy of last years tax return with the personal info blacked out to prove my wife is still a dependent and therefore eligible for health ...Alight's Plan-Smart solution is differentiated in the benefits and HR industry by our streamlined and comprehensive audit services. We offer objective and consistent services alleviating an internal need to establish technology and process. We protect your organization through third-party objectivity, which preserves employee goodwill.Take advantage of internal communication. Internal communication is the best approach to prepare employees for a dependent eligibility verification for a variety of reasons. Employees trust communications from their employer, which is very important when asking for personal documentation. Use internal communications and clear, simple messaging.Purpose of yourdependentverification plan smart info online or discover that substantiates the new message, optimize and ers building is only. Claims in annual com plan smart info which this your spend and scale your message, is the deva. Procedure is yourdependentverification plan smart info which enable one to.Mercer LLC, a global human resource consulting firm that does dependent verification for employers, saw client requests for audits more than double each year from 2006 to 2008. The growth slowed a bit last year, but then picked up again in 2010, with a 30 to 40 percent increase over 2009, says Rich VanThournout, Mercer's health and benefits ...Contact HISD Benefits Office at 713-556-6655 for assistance completing the Disabled Dependent application. Eligible dependent grandchildren under the age of 26 may be covered if you provide required documentation. Dependent verification. You're required to provide documentation to support the eligibility status of each of your dependents.Please enter your Plan-Smart password to view this report:You may also submit your documents via secure fax using the enclosed fax cover page or US mail: Secure Fax: 1-866-961-6881 (Allow 5 days for documentation to be reviewed; you can view your verification status online.) Mail: Dependent Verification Center, PO Box 1403, Lincolnshire, IL 60069-1403 (Allow 21 days from mail date for documentation to be reviewed and a response to be received via US ...Dependent Eligibility Verification. Please select your preferred language.Please enter your Plan-Smart password to view this report:Dependent Verification By The Numbers Why verifying dependent eligibility is so important for employers 6-8% Average % dependents identified as ineligible in a full audit Benefit costs are on the rise. Research from our 2021 Benefits Benchmark Reportfound average annual premiums on Family health plans increased 49% over the last 5 years 10-12%Alight offers solutions to verify and audit dependent eligibility and compliance for health benefits plans. Learn how to save costs, reduce risks and integrate with cloud-based platform.Site Registration - Step 1. Please enter the following information in order to register for access to this site. (Please enter your Audit ID exactly as it appears in your Dependent Verification Packet.) * Required * Please enter a valid date of birth. (Enter the date in "MM/DD/YYYY" format. For example, January 5, 1970 should be entered as "01 ...Dependent Verification. The first time you enroll new dependents in Citi Benefits, you will be asked to report information about each of your eligible dependents, such as name, date of birth, Social Security number and, if over age 26, whether the child has a mental or physical disability. You will also be required to submit proof of the ...What is dependent verification? "Dependent verification" is the process that requires you to verify your dependents are your dependents. This process ensures the SEBB Program only covers people who qualify. There are two exceptions: Extended dependent children are reviewed through a separate process. For details, see the SEBB Extended …Just call us, and we'll reschedule or stop your automated plan. You'll need to make payment to your lender on your own. You can stop or restart the program at any time. What's your contact information? Email: [email protected] Client Support: 800.481.6863 Sales: 888.887.6278 (888.88.SMART) Fax: 866.728.1370 Mailing address: 500 W. 2nd Street ...220 S 27thStreet, #B * Tacoma WA 98402 (253) 474-1214 or (800) 223-2449 Fax: (253) 474-7180 E-mail: [email protected] Website: www.unitedemployees.org. Healthcare costs continue to rise for the Trust and participants. One factor contributing to the increase is the cost of covering dependents that are not eligible for plan benefits.The Savings Power of This FSA. A Dependent Care FSA (DCFSA) is a pre-tax benefit account used to pay for eligible dependent care services, such as preschool, summer day camp, before or after school programs, and child or adult daycare. It's a smart, simple way to save money while taking care of your loved ones so that you can continue to work.This is called dependent verification. It is required in most cases, even if you have previously verified your dependents' eligibility. Submit verification documents by November 15, 2019. You must submit valid verification documents for any dependents you wish to enroll by 11:59 p.m. on November 15, 2019 ...Alight Plan-Smart is the leader in dependent eligibility audit solutions. About Plan-Smart; ROI Calculator; About Plan-Guard; Claims and Appeals Management ... While the majority of calls we receive in our Dependent Verification Center are from employees calling to check to see if their documents have been received and are acceptable, employers ...Aug 18, 2023 · Dependent Audit 2023. Beginning in mid-June, Trinity Health will be conducting a dependent audit to confirm that only eligible individuals are covered under our benefit plans. This effort is part of our continuous review of programs to ensure we are being good stewards of our resources. We have engaged Alight Solutions to validate dependent ...Are you dreaming of a kitchen renovation but worried about the cost? Remodeling your kitchen can be an exciting project, but it’s important to plan ahead and stick to a budget. One...STEP 1:Review the list of the dependents you have enrolled and match each of them to a dependent type listed in the “Eligibility Rules and Documentation Required” section. STEP 2:For each dependent type you will find the eligibility requirements and a list of document options required to verify that particular dependent type. A dependent verification review is not a fishing expedition or witch hunt. It should
By Fax. By Email. Winston Financial Services Attn: Montefiore Dependent Audit P.O. Box 430 Manasquan, , NJ 08736. (732) 903-1166. [email protected]. View your verification status within 3-4 business days upon receipt by Winston. View your verification status within 2-3 business days upon receipt by Winston.Login to securely upload verification documents for your dependent(s) and check the status.This city and county government approached BMI to help confirm if health care plan dollars were being spent appropriately by verifying the eligibility of 7,596 enrolled dependents. Dependent Eligibility Verification Services. Prior to the move to Part D Advisors, Health Decisions was already a leading national firm in the area of Dependent Verification. Our proven high-quality, high-tech, high-touch method surveys employees with dependents to request required documentation. Averaging a 98% employee response rate, along ...Object moved to here.One ADP Boulevard, MS 325, Roseland, NJ 07068-1728, Attn: John Gevertz. JURISDICTION/GOVERNING LAW. These terms and conditions shall be governed and construed in accordance with the laws of the State of New Jersey, USA, and applicable federal laws without regard to conflicts of law principles. User agrees that any and all proceedings relating ...Learn about the eligibility, interest rate, and repayment options of federal parent PLUS loans for your child's education.Plan-Guard Ongoing Dependent Verification Service assures that the number of enrolled dependents on your plans is a true reflection of their eligibility status. Our flexible solution ensures that the verification process meets the specific requirement of your organization while minimizing your HR team's time commitment.Below is a list of all dependent eligibility documentation requirements for health benefits coverage for dependents. ... Disabled status for any child still requires current medical certification from the health plan in addition to ... Dependent_Verification.docx 9/2015 :Fully managed tax-advantaged benefit accounts to level up portfolios. R. Dependent Verification. Reduce costs with AI dependent verification and auditing services. Custom Communications. Personalize your employee benefit communications for engagement. P. ACA Add-On Services. Simplify ACA management with state reporting and fulfillment …Employees Retirement System of Texas. 200 East 18th Street Austin, TX 78701. Toll-free: (877) 275-4377 TTY: 711 Fax: (512) 867-7438. Contact ERSWhen you’re looking for a new high-yield savings account, there are several points you should consider closely along the way. Precisely which points matter may depend on how you pl...What's new in milConnect? 03/14/2024 Version 9.08. Online Help Accessibility Enhancements. Recent News. 01/15/2024: Request a Copy of your Updated IRS Form 1095. News Archives. Manage contact information, check records and benefits.You may also submit your documents via secure fax using the enclosed fax cover page or US mail: Secure Fax: 1-866-961-6881 (Allow 5 days for documentation to be reviewed; you can view your verification status online.) Mail: Dependent Verification Center, PO Box 1403, Lincolnshire, IL 60069-1403 (Allow 21 days from mail date for documentation to be reviewed and a response to be received via US ...Found. The document has moved here.Dependent Verification Center. 16. What information do I need to provide if my stepchildren are on my Plan? In order for stepchildren to be covered on an employee’s plan, your spouse (the children’s biological parent) must also be covered on your plan.www.yourdependentverification.com-smart-info. April 3, 2023 admin. Are you tired of the hassle and confusion that comes with managing your financial aid verification? Look no further than www.yourdependentverification.com-smart-info! With their Plan Smart Info program, navigating the verification….Respond quickly and accurately. You usually have 30 to 45 days to respond to a dependent eligibility audit, and some offer an amnesty period. If your dependent is found to be ineligible during this period, you will likely not be held responsible for any past payments. Plan for coverage extension for children under 26.- Time and Cost Savings: By automating the dependent verification process, organizations can save time and reduce administrative costs associated with manual verification. - Enhanced Data Accuracy: The platform's automated verification processes help minimize errors and ensure that only eligible dependents are covered under benefit plans.Sample: {Reminder Notice} Dear {Participant Name}: To ensure only eligible dependents of State retirees are enrolled in employer-sponsored health and/or dental coverage, California Government Code Section 22843.1 and California Code of Regulations Section 599.855 requires CalPERS to re-verify the eligibility of your dependent(s) at least once ...Title: frm_rpt_pdf.aspx Author: AH0124901 Created Date: 3/14/2017 2:57:51 PMDependent Verification is the process of validating the eligibility of dependents enrolled in the Flexible Benefits Program. Participants with dependents enrolled in the Flexible Benefits plan options must provide the required proof of their dependents' eligibility upon request. Eligible Dependents Legal spouses5 questions to ask about dependent verification. The concept of dependent verification, often times referred to as a dependent audit, has gained popularity in recent years, but the process and strategy still remain misunderstood by many advisers, corporate executives and benefit teams. For reprint and licensing requests for this article, click ...Dependent Eligibility Verification (DEV) To ensure only eligible dependents of State employees are enrolled in employer-sponsored health coverage, California Government Code Section 22842.1 requires your employer to verify the eligibility of your dependent (s) at least once every three years. The DEV process was authorized by Senate Bill (SB ...2908 "C:\Program Files\Google\Chrome\Application\chrome.exe" --type=renderer --field-trial-handle=1032,8792541378595596295,2334159481139442011,131072 --enable ...Next Steps. Take an honest look at your parents' financial situation and how it's affecting your own. If you're not comfortable doing this alone or you need some more guidance on next steps, you can always do this sit-down with a financial advisor. A matching tool like SmartAsset's SmartAdvisor can help you find a person to work with to ...YourDependentVerification is your login portal site that was Created by the plan smart through which the members of the plan smart can create a sign in which permits them to access their plan info. Links to Verification Sources Throughout the audit process, you have access to a dedicated website—www. www. Web we pair powerful ai/ml technology …Health plan enrollment fraud occurs when a person or company intentionally misrepresents facts to improperly receive health care products and services.Booking a hotel at a discounted rate is a smart way to save money while enjoying a comfortable stay. Whether you are planning a vacation or a business trip, finding the best deals ...Phone: 1-800-562-3022. Email: [email protected] How to Cancel Your Health Plan Online. Cancel one household member's health plan: Sign into your account. Go to your Dashboard and select "Report a Change" from the Account Home section. Answer "Yes" to the statement "I need to add or remove someone from my household.".yourdependentverification.com receives about 17,748 unique visitors per day, and it is ranked 387,773 in the world. yourdependentverification.com uses Amazon ALB, HSTS, Amazon Web Services web technologies. yourdependentverification.com links to network IP address 18.207.70.139. Find more data about yourdependentverification.Dependent Verification. The first time you enroll new dependents in Citi Benefits, you will be asked to report information about each of your eligible dependents, such as name, date of birth, Social Security number and, if over age 26, whether the child has a mental or physical disability. You will also be required to submit proof of the ...There are a variety of reasons companies choose to verify the eligibility of dependents. Reduce future dependent health care costs for you, the employee. Improve employee understanding of health care costs and each employee's own responsibility for controlling these costs. Reduce compliance risk under Sarbanes-Oxley, ERISA and DOL guidelines.02. Access the verification form: Visit the appropriate website or contact the organization requesting the verification to obtain the necessary form. It may be available for download online or through a physical form. 03. Fill in personal information: Start by filling in your personal information, such as your name, address, contact information ...Please enter your Plan-Smart password to view this report:02. Upload documentation. Upon completing enrollment, the employee receives a notification detailing the information required in order to verify the dependent’s eligibility for coverage. To complete the verification process, the employee takes a photo of the supporting documentation and uploads it to the portal directly from their mobile ...Review the list of the dependents you have enrolled and match each of them to a dependent type listed in the "Eligibility Rules and Documentation Required" section. ... [ June 3, 2023 ] www.tv.youtube tv/start Enter Code : YouTube Link your Mobile Device to your Smart TV news [ June 3, 2023 ] Qantas ...5 questions to ask about dependent verification. The concept of dependent verification, often times referred to as a dependent audit, has gained popularity in recent years, but the process and strategy still remain misunderstood by many advisers, corporate executives and benefit teams. For reprint and licensing requests for this article, click ...Clearify Dependent Verification. English. Spanish. Manage your dependent verification. Login to securely upload verification documents for your dependent (s) and check the status. User name. Password. Remember me.Employees Retirement System of Texas. 200 East 18th Street Austin, TX 78701. Toll-free: (877) 275-4377 TTY: 711 Fax: (512) 867-7438. Contact ERSSecurity and contact info. The Trust takes the security of your personal information seriously. This is why we have partnered with Alight, a national employee benefits firm with the proven experience, security and confidentiality protocols to manage the dependent verification process. ... Employees can contact the Alight Dependent Verification ...Dependent Eligibility Verification Services. Prior to the move to Part D Advisors, Health Decisions was already a leading national firm in the area of Dependent Verification. Our proven high-quality, high-tech, high-touch method surveys employees with dependents to request required documentation. Averaging a 98% employee response rate, along ...If you have not verified your dependents with Alight as of October 5, 2018, you will be receiving a letter stating your dependent's coverage will be terminated effective November 30, 2018. In an effort to give you every opportunity to provide your documents and avoid any disruptions in your dependent's coverage, the Office of Human ...Please enter your Plan-Smart password to view this report:Just call us, and we'll reschedule or stop your automated plan. You'll need to make payment to your lender on your own. You can stop or restart the program at any time. What's your contact information? Email: [email protected] Client Support: 800.481.6863 Sales: 888.887.6278 (888.88.SMART) Fax: 866.728.1370 Mailing address: 500 W. 2nd Street ... Declaration of Domestic Partner & Acknowledgements. We each certify and declare under oath that we are domestic