Hbd 40 calpers 2026

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The document is an Affidavit of Parent-Child Relationship under California Code of Regulations section 599.500(o), which allows employees and annuitants to enroll children in a CalPERS-sponsored health plan if they have assumed a parental role. It outlines the requirements for establishing this relationship, including responsibilities for care and support, and mandates annual certification for each child up to age 26. The affidavit must be signed by the employee or annuitant, certifying the truthfulness of the information provided.

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Click ‘Get Form’ to open the hbd 40 calpers document in the editor.
Begin by filling out the Employee/Annuitant Information section. Enter your name, Social Security Number, and the date you assumed primary custodial parental role for the child.
Next, provide your relationship to the child and complete the Child Information section. Include the child's name, Social Security Number, address (if different), and date of birth.
Indicate whether you have enrolled other children under CCR section 599.500(o) by selecting 'Yes' or 'No'. If yes, specify how many children are enrolled.
In the Eligibility section, certify your parent-child relationship by answering each question with 'Yes' or 'No', and initialing where required.
Finally, review all information for accuracy before signing and dating the document at the bottom.

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Versions	Form popularity	Fillable & printable
2013	4.9 Satisfied (495 Votes)
2010	4.3 Satisfied (46 Votes)

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