CIS Forms

If you need an enrollment form to add or delete a dependent from your coverage, please see your Benefits/HR representative.

CIS Forms

Affidavit of Dependency
This form is required to verify dependent eligibility status of an unmarried child under the age of 23.

Affidavit of Qualifying Incapacitated Dependent Eligibility
this form is required to certify that your child, who is over the age of 23, is incapacitated due to a medical disability, developmental disability or mental disorder.

Certificate of Domestic Partnership
This form is required to add a domestic partner to your coverage (The county Certificate of Registered Domestic Partnership is also allowed)

Termination of Domestic Partnership Form
This form is required to delete a domestic partner from your coverage.