Enter the first name of the dependent/beneficiary.

Enter the middle name of the dependent/beneficiary.

Enter the last name of the dependent/beneficiary.

Enter the dependent/beneficiary's social security number or government ID number.

Use this drop-down box to select the relationship of the dependent/beneficiary to you.

In this field, you can enter the other relationship of the dependent/beneficiary to you.  This field is enabled when you select "Other" from the Relationship drop-down box.

Note:  If you select "Other" in the Relationship drop-down box, the Other Relationship field will be required. If you do not enter a value in this case, the system will display the following message:  "Other Relationship is required when "Other" is selected as the Relationship."

Select the gender of the dependent/beneficiary from the drop-down box.

Select the appropriate radio button:  Dependent Only, Beneficiary Only, or Dependents/Beneficiaries.

Select the Student or the Handicapped checkbox, or both, if applicable.

Use Calendar Lookup to select the date of birth (or the date of a legal agreement/document, such as an adoption agreement) of the dependent/beneficiary.

Select this checkbox when the dependent/beneficiary's mailing address is the same as yours.

Enter up to a 30-character, alphanumeric street address, line 1, for the dependent/beneficiary.

Enter up to a 30-character, alphanumeric street address, line 2, for the dependent/beneficiary.

Enter up to a 30-character, alphanumeric street address, line 3, for the dependent/beneficiary.

Enter up to 25 alphanumeric characters for the dependent/beneficiary's address city.

Use the drop-down box to select the state/province for the address entered/displayed on the screen.  The valid values are the states/provinces set up in Costpoint for the selected country.  

Enter up to a 10-character, alphanumeric postal code for the dependent/beneficiary.

This field shows how the postal code should be entered on the screen (if the postal code is validated, as determined by the Self Service Configuration screen).

Use the drop-down box to select the country for the address entered/displayed on the screen.  The valid values are the countries set up in Costpoint.  If you make a different selection in the Country field, the State/Province drop-down box will repopulate with valid values based on the country selected.

Enter up to 25 alphanumeric characters for the dependent/beneficiary's home telephone information.

Enter up to 25 alphanumeric characters for the dependent/beneficiary's business telephone information.

Select this pushbutton to return to the Dependents/Beneficiaries screen without saving any changes.

Select this pushbutton to reset any changes made back to what was in the system when you first entered the screen (before making any changes).

Select this pushbutton to save any changes to the database and to return to the Dependents/Beneficiaries screen, which will display the updated record in the Dependents/Beneficiaries table.