Web1 de mar. de 2024 · Download Fillable Form Ps-425.4 In Pdf - The Latest Version Applicable For 2024. Fill Out The Termination Of Domestic Partnership For Nyship - New York … WebRule 152 (PS-425,.3) Dependent Children Your unmarried children under age 19 are eligible. Eligible dependents include: your natural children legally adopted children, including children in a waiting period prior to finalization of adoption your dependent stepchildren, including dependents of same-sex spouse
answer “YES” to all of the
WebContribution Program, that the dependent portion of the cost of my NYSHIP family coverage will be taken on a post-tax basis because my dependent is not federally qualified I understand that I will be required to complete Form PS-425.3, Dependent Tax Affidavit, if my dependent’s status under IRC section 152 changes at any time. WebNew York State Health Insurance Program (NYSHIP) ... PS-425 Application & Instructions for Enrolling Domestic Partner; Termination of Domestic Partnership (PS-425.4) Retiree … jessica on fox\u0027s the five
NYSHIP Termination of Domestic Partnership (PS-425.4)
http://uupinfo.org/benefits/pdf/NYSHIPEligibilityAudit160517.pdf WebMust be provided when choosing to enroll or opt-out of NYSHIP family coverage (use additional sheets if necessary) Check One: A (Add), D (Delete) or C ... (Attach completed PS-425.4) Only dependent ineligible due to age I voluntarily cancel coverage for my dependents ... you must also complete the PS-409 Opt-out Attestation Form. Webaffirmation to NYSHIP that I am not subject to federal tax withholding for any imputed income resulting from benefits extended to my Domestic Partner. I understand that I will … inspection sticker texas online