Qualifying Status Change Forms

PEIP Correction Form 2023

2023_PEIP_Correction_Form.pdf 1.83 MB (Last Modified on November 1, 2022)

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Medica Correction Form 2023

2023_Medica_Correction_Form.pdf 2.16 MB (Last Modified on November 1, 2022)

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Non-PEIP Qualifying Status Change Form

2021_NON_PEIP_QSC_Fillable_with_Comments.pdf 2.08 MB (Last Modified on February 3, 2021)

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PEIP Qualifying Status Change Form

Use this form to apply for a Qualifying Status Change - Documentation of change required.

2021_PEIP_QSC_Fillable_with_Comments.pdf 2.07 MB (Last Modified on February 3, 2021)

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Dependent Verification Documents Accepted

Use this guide to determine what documentation for your status change will be accepted.

QSC Dependent Verification Documents.pdf 253.34 KB (Last Modified on May 2, 2018)

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SPPS Employee Forms