Certification For Foster Children Form printable pdf download

Certification For Foster Children Form

Attachment 2

CERTIFICATION FOR FOSTER CHILDREN

I have been informed of the following requirements for certifying foster child eligibility

as a Qualifying Life Event (QLE) under the Federal Employees' Group Life Insurance

Program:

1. The child must be unmarried and under age 22. (If the child is over age 22, he/she can

only be covered if he/she is incapable of self-support because of a disabling condition

that began before age 22. I must provide documentation of this to my employing

office.);

2. the child must be living with me;

3. the parent-child relationship must be with me, not with the biological parent. This

means that I am exercising parental authority, responsibility, and control; I am caring

for, supporting, disciplining, and guiding the child; and I am making the decisions

about the child's education and medical care;

4. I must be the primary source of financial support for the child; and

5. I must expect to raise the child to adulthood.

I understand that if the child moves out of my home to live with a biological parent,

he/she loses coverage and cannot ever again be covered as a foster child unless:

1. The biological parent dies;

2. The biological parent is imprisoned;

3. The biological parent becomes incapable of caring for the child due to a

disability; or

4. I obtain a court order taking parental responsibility away from the biological

parent and giving it to me.

This is to certify that: _______________________ [name of child] lives with me; I have

a regular parent-child relationship with _______________________ [name of child], as

described above; I am the primary source of financial support for __________________

[name of child]; and I intend to raise ___________________ [name of child] into

adulthood.

I will immediately notify my employing office if the child marries, moves out of my

home, or ceases to be financially dependent on me.

__________________________________________________

Print name

DOB

__________________________________________________

Address

__________________________________________________

Signature

Date

Certification For Foster Children Form