In navigating the complexities of employee benefits administration, particularly within the sphere of government employment, the Management Benefits Fund (MBF) Dependent Eligibility Form emerges as a pivotal document. Centered in the bustling environment of New York City, the Office of Labor Relations provides an avenue through which members can enroll their young adult dependents, aged 19-26, not previously covered under an MBF member's plan. This specific procedural step delineates a significant portion of the management benefits terrain, offering clarity on eligibility criteria that notably bypasses the conventional prerequisites of financial dependency, residency, or marital status. Required documentation, such as birth certificates, adoption agreements, or court orders establishing guardianship, underscores a streamlined yet rigorous verification of dependent status. Additionally, the form accentuates the importance of precise member information, including personal identifiers and agency affiliation, as a foundational step in securing the welfare benefits. This comprehensive approach, facilitated through both direct office contacts and accessible online resources, reflects a broader commitment to ensuring that eligible young adults receive the support they deserve, within the specified age range, thus reinforcing the protective mantle of benefits coverage in a manner that is both inclusive and efficient.
| Question | Answer |
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| Form Name | Management Benefits Fund Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | management benefits fund, management benefits fund forms, nyc management benefits fund, city of new york management benefits fund |
OFFICE OF LABOR RELATIONS
Management Benefits Fund
40 Rector Street, Third Floor, New York, N.Y. 10006
Tel: (212)
nyc.gov/olr
DEPENDENT ELIGIBILITY FORM FOR YOUNG ADULT CHILDREN (AGES
This form only can be used to enroll young adult dependents (ages
MEMBER INFORMATION
LAST NAME: |
FIRST NAME: |
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MI:
SOCIAL SECURITY#:
AGENCY NAME:
ADDRESS (NUMBER AND STREET):
APT:
CITY:
STATE:
ZIP CODE:
DEPENDENT INFORMATION
Deinition of dependent: Dependent children include natural and adopted children, and children for whom you are the legal guardian, up to age 26. Please note that there are no inancial dependency, residency, student status or marital status requirements for dependents.
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SOCIAL SECURITY NUMBER: |
DATE OF BIRTH: |
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RELATIONSHIP: |
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LAST NAME: |
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FIRST NAME: |
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MI: |
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I AM ATTACHING THE FOLLOWING AS PROOF OF DEPENDENCY: ❑ BIRTH CERTIFICATE |
❑ ADOPTION AGREEMENT |
❑ COURT ORDER ESTABLISHING GUARDIANSHIP |
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SOCIAL SECURITY NUMBER: |
DATE OF BIRTH: |
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RELATIONSHIP: |
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LAST NAME: |
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FIRST NAME: |
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MI: |
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I AM ATTACHING THE FOLLOWING AS PROOF OF DEPENDENCY: ❑ BIRTH CERTIFICATE |
❑ ADOPTION AGREEMENT |
❑ COURT ORDER ESTABLISHING GUARDIANSHIP |
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SOCIAL SECURITY NUMBER: |
DATE OF BIRTH: |
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RELATIONSHIP: |
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3. |
LAST NAME: |
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FIRST NAME: |
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MI: |
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I AM ATTACHING THE FOLLOWING AS PROOF OF DEPENDENCY: ❑ BIRTH CERTIFICATE |
❑ ADOPTION AGREEMENT |
❑ COURT ORDER ESTABLISHING GUARDIANSHIP |
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MEMBER SIGNATURE
I certify that my dependent(s) meets the requirements for eligibility as a dependent and that all of the above information is correct.
SIGNATURE:
MBF ADMINISTRATIVE OFFICE USE ONLY
DATE:
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PROCESS DATE |
PROCESSED BY |
APPROVAL DATE |
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OLR/FORMS/DEF_FORM.INDD 1/11