Phs 1637-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Social Security Number (SSN) and full name in the designated fields. Ensure accuracy as this information is crucial for processing.
3. In the 'Purpose' section, select whether you are establishing initial dependency or re-certifying an existing one by placing an 'X' in the appropriate box.
4. Fill out your marital status and provide details of any dependents, including their names, addresses, and dates of birth. If applicable, include information about legal custody.
5. Complete the financial contribution section for each dependent, detailing monthly contributions and any required court support amounts.
6. If claiming a child over 21 who is handicapped, attach a physician's statement as instructed. Ensure all necessary documentation is included before submission.
7. Review all entries for accuracy and completeness before signing and dating the form at the bottom.

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