{"id":3870,"date":"2022-01-24T15:46:31","date_gmt":"2022-01-24T15:46:31","guid":{"rendered":"https:\/\/myaci-benefits.com\/?page_id=3870"},"modified":"2024-06-12T17:57:04","modified_gmt":"2024-06-13T00:57:04","slug":"forms","status":"publish","type":"page","link":"https:\/\/myaci.altimateqod.com\/us\/resources\/forms\/","title":{"rendered":"Benefit Forms"},"content":{"rendered":"

Here you will find a several benefit forms and dependent verification requirements.<\/p>\n<\/div><\/div><\/div>

Dependent Verification Requirements<\/a><\/p>\n<\/div>

<\/div><\/div>

Domestic Partnership Affidavit<\/a><\/p>\n<\/div>

<\/div><\/div>

Certification of Healthcare Provider Form (LOA-Related Form)<\/a><\/p>\n

You and your doctor (or your family member’s doctor if taking a care of a family member leave) must complete this form if you are taking a medical leave for yourself, pregnancy\/childbirth leave or care of a family member leave.<\/p>\n<\/div>

<\/div><\/div>

Healthcare Provider Status Form (LOA-Related Form)<\/a><\/p>\n

You and your doctor must complete this form if you are taking a medical leave for yourself in order for your doctor to indicate you are released to return to work at the end of your leave of absence.<\/p>\n<\/div><\/div><\/div><\/div><\/div>

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