Division of Human Resources (DHR)

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Division of Human Resources (DHR)

DEPENDENCY ALLOWANCES

GUIDELINES

UNICEF

Division of Human Resources (DHR) Dependency Allowances CF/AI/2001-003 of 29 January 2001

CF/AI/2001-003 of 29 January 2001

2 Dependency Allowances CF/AI/2001-003 of 29 January 2001

DEPENDENCY ALLOWANCES TABLE OF CONTENTS

Page

I. General...... 3 What is the Purpose of a Dependency Allowance? ...... 3 Who is Eligible? ...... 3

II. Dependent Spouse...... 5 Who is a Dependent Spouse? ...... 5 Which Country's Law is used for Determining Marital Status? ...... 5 Is a Common Law Marriage Recognized? ...... 6 What happens when there is more than one Spouse?...... 6 What happens when the Staff Member is Legally Separated?...... 6 What happens when the Staff Member is Divorced? ...... 7 How much is the Allowance? ...... 7 What happens when both Spouses are UNICEF/UN Staff Members? ...... 8

III. Dependent Child...... 9 Who is a Dependent Child? ...... 9 Who is a Dependent Disabled Child? ...... 10 How much is the Allowance? ...... 10 What happens when both Spouses are UNICEF/UN Staff Members? ...... 11 What happens when a Government Grant is being paid? ...... 11

IV. Secondary Dependent...... 13 Who is a Secondary Dependent? ...... 13 How much is the Allowance...... 13

1 Dependency Allowances CF/AI/2001-003 of 29 January 2001

V. Payment ...... 15 Are Dependency Allowances paid Automatically? ...... 15 How to Claim/Change Dependency Benefits? ...... 15 What is the required Supporting Documentation? ...... 17

ANNEXES...... 23 A. Gross Salary GS-2 Step 1 New York General Service Salary Scale...... 23 B. Dependency Status Form - UNICEF 468 (01/01)...... 25 C. Dependency Status Form - UNICEF 469 (01/01)...... 27 D. Sample Inter-Office Memorandum to the UN Medical Services Division requesting Special Dependency Allowance for a Locally-Recruited Staff Member...... 29

2 Dependency Allowances CF/AI/2001-003 of 29 January 2001

I. General

What is the Purpose of a Dependency Allowance?

1. Dependency allowance is a social benefit paid to a staff member in respect of his/her eligible dependents.

Who is Eligible?

2. Staff Members under the 100 Series of the United Nations (UN) Staff Rules. Subject to meeting the eligibility criteria described below, staff under the 100 Series of the UN Staff Rules are entitled to receive allowances in respect of:

a) a dependent child (or children);

b) a dependent spouse; or

c) a secondary dependent.

3. Staff Members under the 200 Series of the UN Staff Rules. Staff under the 200 Series of the UN Staff Rules who are granted an initial fixed-term appointment of:

a) less than one year are not entitled to the allowances in paragraph 2 above;

b) one year or more are entitled to the allowances in paragraph 2 above as from the initial date of the appointment; and

c) less than one year but subsequently extended so that the total continuous service is of one year or more, are entitled to the allowances in paragraph 2 above as from the date on which their fixed-term appointment is extended.

3 Dependency Allowances CF/AI/2001-003 of 29 January 2001

4 Dependency Allowances CF/AI/2001-003 of 29 January 2001

II. Dependent Spouse

Who is a Dependent Spouse?

4. A spouse of a staff member is considered dependent when he/she has no occupational earnings or his/her annual gross occupational earnings (gross, before tax) are less than:

a) For internationally-recruited professional staff members, the gross salary of level G-2 step 1 of the New York general service (GS) salary scale in force on 1 January of the year concerned, irrespective of the country in which the spouse is employed. DHR will inform internationally-recruited staff members of such amount on a yearly basis (Annex A contains the amounts since 1995);

b) For internationally-recruited general service staff members, the lowest entry level of the GS gross salary scale in force on 1 January of the year concerned for the closest duty station in the country of the spouse's place of work; and

c) For locally-recruited staff members, the lowest entry level of the GS gross salary scale in force on 1 January of the year concerned for the closest duty station in the country of the spouse's place of work.

5. Pension income, such as retirement and disability benefits, and income resulting solely from investment, are not included in the computation of the annual gross occupational earnings.

6. If a staff member is in service or has been married for less than the full calendar year, the spouse's occupational earnings for the full year will be taken into account to determine eligibility in relation to the earnings limit established for that year.

Which Country's Law is used for determining Marital Status?

7. The law of a staff member's home country is used by UNICEF as the point of reference in determining a staff member's marital status for administrative purposes, i.e., the home country is the forum state (the state in whose courts the case is brought). Therefore, for example, if the marriage is not recognized by the home country, UNICEF will not recognize it for purposes of entitlements under the UN Staff Rules and Regulations, irrespective of the validity/non-validity of the marriage, where contracted.

Is a Common Law Marriage Recognized?

5 Dependency Allowances CF/AI/2001-003 of 29 January 2001

8. A common law marriage is an agreement between a man and a woman to marry, followed by cohabitation, without ecclesiastical or civil ceremony, such agreement being evidenced by the writings, declarations, or conduct of the parties. In many jurisdictions it is not recognized.

9. A common law marriage, where recognized, is a legal marriage with the same basic pre- requisites and consequences as a formally solemnized marriage. A common law marriage remains valid until legally dissolved and thus would constitute an impediment to a subsequent marriage by either spouse.

10. If a common law marriage is valid, where contracted, and is recognized by the law of a staff member's home country, UNICEF will recognize it.

11. UNICEF’s acceptance of a person as a "spouse" will not, in any case (common law or other form of marriage), preclude further review should a question of a prior existing marriage arise at any time, nor will it conclusively determine the rights of competing claimants to entitlements as surviving spouses under UN or United Nations Joint Staff Pension Fund (UNJSPF) Rules and Regulations.

What happens when there is more than one Spouse?

12. For the purpose of dependency benefits, the UN recognizes only one spouse. Where more than one spouse is legally recognized in the country of nationality, the staff member may elect which spouse to designate for dependency purposes. The names of the other spouses are recorded for Pension Fund purposes.

What happens when the Staff Member is Legally Separated?

13. A staff member who is legally separated may claim dependency benefits in respect of his/her spouse as long as the staff member continues to provide financial support to him/her, and can provide UNICEF with proof thereof.

What happens when the Staff Member is Divorced?

14. A staff member who is legally divorced may not claim dependency benefits in respect of his/her ex-spouse.

6 Dependency Allowances CF/AI/2001-003 of 29 January 2001

How much is the Allowance?

15. For Internationally-Recruited Professional Staff Members. Internationally-recruited professional staff members with a dependent spouse receive, in lieu of a separate allowance, their net salary and post adjustment at the dependency rate. Lump sum portion of the assignment grant, mobility and hardship (M&H) allowance, and repatriation grant (where applicable), are also paid at the dependency rate.

16. A staff member without a spouse, or whose spouse does not qualify as a dependent, receives the dependency rate of net salary if he/she has dependent children (see Section III of these Guidelines). In such cases, a dependency allowance is not payable in respect of the first child.

17. If the spouse's gross occupational earnings exceed the established level by an amount that is less than the spouse dependency benefits, an appropriate adjustment will be made if there are no dependent children. The lump sum portion of the assignment grant, M&H allowance, and repatriation grant (where applicable), are paid at the single rate.

18. For Internationally-Recruited General Service Staff Members. Internationally- recruited general service (GN) staff members with a dependent spouse receive a lump sum payment in addition to their net salary. The amount of the allowance is provided in the New York GS salary scale.

19. If the spouse's gross occupational earnings exceed the established level by an amount that is less than the spouse dependency benefits, an appropriate adjustment will be made. Lump sum portion of the assignment grant, M&H allowance, and repatriation grant (where applicable) are paid at the single rate.

20. For Locally-Recruited Staff Members. Locally-recruited staff members with a dependent spouse receive a lump sum payment in addition to their net salary only when local conditions and/or practices of comparator employers call for the establishment of such an allowance. The amount of the allowance, if any, is provided in the local salary scale applicable at the duty station.

21. If the spouse's occupational earnings exceed the established level by an amount that is less than the spouse's dependency benefits, an appropriate adjustment is made.

What happens when Both Spouses are UNICEF/UN Staff Members?

22. If both spouses are staff members of UNICEF or one is employed by another UN system organization, and both are in the international professional category, each is paid salary

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and post adjustment at the single rate unless there is a dependent child, in which case the provisions of paragraph 35 apply.

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III. Dependent Child

Who is a Dependent Child?

23. A dependent child is any of the following children under the age of 18 years or, if the child is in full-time attendance at a school or university (or similar educational institution), under the age of 21, for whom the staff member provides main and continuing support:

a) a staff member's natural child;

b) a staff member's legally adopted child; and

c) a staff member's stepchild, if residing with the staff member.

24. If legal adoption of the child is not possible because there is no statutory provision for adoption or any prescribed court procedure for formal recognition of customary or de facto adoption in the staff member's home country or country of permanent residence, then a child in respect of whom the following conditions are met can be recognized as a dependent:

a) the child resides with the staff member;

b) the staff member can be regarded as having established a parental relationship with the child;

c) the child is not a brother or sister of the staff member;

d) the staff member has permanently assumed full responsibility for the care, education and upbringing of the child; and

e) the number of children for which dependency benefits are claimed under this paragraph does not exceed three.

25. Attendance at a boarding school, or a similar educational arrangement, is not interpreted as meaning that a child is not residing with the staff member.

9 Dependency Allowances CF/AI/2001-003 of 29 January 2001

Who is a Dependent Disabled Child?

26. A disabled child, for purposes of the dependency allowance, is a child who is physically or mentally disabled, either permanently or for a period expected to be of long duration. The UN Medical Director makes the determination of disability on the basis of satisfactory medical documentation (see paragraphs 62 to 63).

27. The age and school attendance requirements mentioned in paragraph 23 are waived if the UN Medical Director certifies that the child is physically or mentally incapacitated for substantial gainful employment, either permanently or for a period expected to be of long duration.

How much is the Allowance?

28. For Internationally-Recruited Professional Staff Members. If the staff member:

a) has a dependent spouse, a dependency allowance at the rate of US$1,9361 per annum is payable in respect of each child recognized as a dependent; or

b) does not have a dependent spouse, salary is payable at the dependency rate for the first child and a dependency allowance at the rate of US$1,9361 per annum is payable in respect of each additional child recognized as a dependent.

29. For a dependent disabled child, the amount is US$3,8721 per year. If the staff member has no dependent spouse and is entitled to salary at the dependency rate in respect of the disabled child, he/she also receives an allowance at the rate will be US$1,9361 per annum for that child.

30. For Internationally-Recruited General Service Staff Members. A dependency allowance is payable in respect of each child recognized as a dependent at the rate provided in the New York GS salary scale.

31. For disabled child, the amount is double the rate of the regular child dependency allowance.

1 Amount applicable as of the date of issuance of these guidelines. 10 Dependency Allowances CF/AI/2001-003 of 29 January 2001

32. For Locally-Recruited Staff Members. At those duty stations where there:

a) is no local practice to provide a dependent child benefit, the amount of the allowance is set at three per cent of the mid-point of the local salary scale; and

b) is local practice to provide a dependent child benefit and the allowance has been set according to the local practice, the minimum amount will also be three per cent of the mid-point of the local salary scale.

33. The number of children for whom dependency allowance is payable for locally-recruited staff members is limited to six.

34. For a disabled child, the amount is double the rate of the regular child dependency allowance. However, at those duty stations where a higher amount of dependency allowance is payable for the first dependent child, and the first dependent child is disabled, the staff member receives for that child:

a) the higher amount of dependency allowance payable for the first child; plus

b) an amount equivalent to the child allowance payable in respect of children other than the first dependent child.

What happens when both Spouses are UNICEF/UN Staff Members?

35. If both spouses are staff members of UNICEF or one is employed by another UN system organization:

a) only one may claim the allowance in respect of their child(ren); and

b) dependency benefits will normally be paid to the spouse receiving the higher salary.

What happens when a Government Grant is being paid?

36. If a staff member, his/her spouse, or any other person with whom the child resides, receives a dependency benefit in the form of a government grant in respect of a child, the amount is subtracted from the allowance payable by UNICEF (see paragraphs 28 to 34).

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12 Dependency Allowances CF/AI/2001-003 of 29 January 2001

IV. Secondary Dependent

Who is a Secondary Dependent?

37. A secondary dependent is a father, mother, brother or sister for whom the staff member provides at least half or more of the total financial support and, in any case, at least twice the amount of the secondary dependent's allowance.

38. The requirement as to age, school attendance and total and permanent disability that apply to dependent children are also applicable to dependent brothers and dependent sisters.

39. An allowance for a secondary dependent is not paid where a dependency benefit is paid in respect of a spouse.

40. The allowance is payable for one secondary dependent only.

41. In the case of local staff, secondary dependency allowance is paid only if provisions for this allowance are included in the salary scales for the particular duty station.

How much is the Allowance?

42. For Internationally-Recruited Professional Staff Members. A staff member with no dependent spouse may receive a dependency allowance at the rate of US$6932 per annum in respect of not more than one secondary dependent, provided that the conditions specified in paragraph 37 are met.

43. For Internationally-Recruited General Service Staff Members. A staff member with no dependent spouse may receive a dependency allowance at the rate provided in the New York GS salary scale in respect of not more than one secondary dependent, provided that the conditions specified in paragraph 37 are met.

44. For Locally-Recruited Staff Members. Locally-recruited staff members receive a dependency allowance with respect to a secondary dependent only when local conditions and/or the practices of comparator employers call for the establishment of such an allowance. The amount of the allowance, if any, is provided in the local salary scale applicable to the duty station.

22 Amount applicable as of the date of issuance of these guidelines. 13 Dependency Allowances CF/AI/2001-003 of 29 January 2001

V. Payment

Are Dependency Allowances paid Automatically?

45. No. Payment of dependency allowances is not automatic. It is the responsibility of staff members to claim dependency allowances for which they consider they may be entitled.

How to Claim or Change Dependency Benefits?

46. A “Dependency Status Form”, either UNICEF 468 (01/01) or UNICEF 469 (01/01), (see Annexes B and C), must be completed :

a) upon entry on duty, Form UNICEF 468 (01/01), (see Annex B); or

b) at any time a change in dependency status occurs , Form UNICEF 469 (01/01), (see Annex C), i.e.

 marriage;

 divorce;

 legal separation;

 birth;

 death;

 children over 18 years ceasing full-time school attendance;

 any changes in government child grants; and

 any changes in dependent spouse earnings.

47. The “Dependency Status Form” together with the supporting documentation (see paragraphs 53 to 70) should be submitted for review and processing of the corresponding personnel action reflecting either the staff member’s entitlement to or discontinuance of the allowance, to:

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a) if internationally-recruited staff member stationed outside NY, the local Human Resources/Operations Officer who will forward the documentation to the Human Resources Officer in DHR serving the duty station;

b) if internationally-recruited staff member stationed in NY, the Senior Human Resources Officer in DHR serving NY;

c) if locally-recruited staff member stationed outside NY, the local Human Resources/Operations Officer; and

d) if locally-recruited staff member stationed in NY, the Senior Human Resources Officer in DHR serving NY.

48. Timely and complete submissions will avoid long periods of retroactive recovery in the case of discontinuance of the entitlement. This is particularly important when a change in spousal earnings or government grant occurs, or cessation of full-time studies alters one's eligibility. In those cases where retroactive recovery is required, the recovery schedule will be the following:

a) if the allowances paid relate to a period of less than one year, the recovery will be in three monthly installments; and

b) if the allowances paid relate to a period exceeding one year, the recovery will be in six monthly installments.

49. Spouses. The dependency allowance for spouses will only be discontinued if the staff member indicates that the spouse has exceeded the established yearly occupational earnings level. If the spouse exceeds the yearly occupational earnings level, it is the responsibility of the staff member to report this by completing and submitting the “Dependency Status Form” UNICEF 469 (01/01) (see Annex C and paragraphs 45 and 46). Staff members who fail to report this change may be subject to disciplinary procedure.

50. Government Grants. The dependency allowance for children will only be adjusted if the staff member indicates that the government grant has changed. If the grant changes, it is the responsibility of the staff member to report this by completing and submitting the “Dependency Status Form” UNICEF 469 (01/01) (see Annex C and paragraphs 45 and 46). Staff members who fail to report this change may be subject to disciplinary procedure.

51. Children between 18 and 21 years. The dependency allowance for children between 18 and 21 years will only be discontinued if the staff member indicates that the child has 15 Dependency Allowances CF/AI/2001-003 of 29 January 2001

ceased to be in full-time school attendance. If a child has ceased to be on full-time school attendance, it is the responsibility of the staff member to report this by completing and submitting the “Dependency Status Form” UNICEF 469 (01/01) (see Annex C and paragraphs 45 and 46). Staff members who fail to report this change may be subject to disciplinary procedure.

52. Children reaching 21 years. The dependency allowance for children reaching the age of 21 will be discontinued automatically effective the date when the child reaches his/her 21st birthday.

What is the required Supporting Documentation?

53. Marital Status. Upon entry on duty or change of marital status, a staff member is required to submit if:

a) married, marriage certificate;

b) married under Common Law:

 documentary proof of validity of common law marriage where contracted;

 letter from a senior or judicial officer from staff member's home country confirming that common law marriage does not violate that country's public policy;

 proof of capacity to marry, i.e. parties must be single (or divorced if previously married); and

 evidence of mutual agreement to fulfil legal obligations of marriage;

c) legally separated, legal separation papers;

d) divorced, divorce certificate; or

e) widowed, death certificate.

54. Spouse. Upon entry on duty or change of marital status, birth certificate, national identity card or national passport of spouse giving full name, date of birth and nationality.

55. If the staff member is claiming dependency allowance, no further supporting documentation will be required but he/she should have the necessary documentation 16 Dependency Allowances CF/AI/2001-003 of 29 January 2001

ready at any time during the five-year period following payment, to clarify or to answer queries arising from a review or audit of the entitlement or related payment (e.g. W-2 form, income tax return form, or certificate of spouse’s gross annual earnings from employer).

56. If the staff member is legally separated and claims dependency allowance, proof of continued financial support to spouse may also be required at any time during the five- year period following the payment.

57. A staff member who at any time during the five-year period following payment of the dependency benefit is requested and is unable to prove eligibility, may be subject to disciplinary procedure.

58. Children under 21. Upon entry on duty or birth of a child, birth certificate, national identity card or national passport of child giving full name, date of birth and nationality.

59. If the staff member is claiming dependency allowance, no further supporting documentation will be required, but he/she should have the necessary documentation ready at any time during the five-year period following payment, to clarify or to answer queries arising from a review or audit of the entitlement or related payment, i.e.:

a) if the child is between 18 and 21, proof of full-time school attendance (e.g. academic institution’s certificate of full-time attendance);

b) if staff member is divorced or legally separated and his/her child does not reside with the staff member, proof that the staff member has assumed responsibility for the main and continuing support of the child (e.g. bank statements, cancelled cheques, bank drafts, or money orders duly date-stamped, showing that payments have been regularly made and, if applicable, continue to be made by the staff member to the dependent); and

c) if the child is married, proof that the staff member has assumed responsibility for the main and continuing support of the child (e.g. bank statements, cancelled cheques, bank drafts, or money orders duly date-stamped, showing that payments have been regularly made and, if applicable, continue to be made by the staff member to the dependent).

60. A staff member who at any time during the five-year period following payment of the dependency benefit is requested and is unable to prove eligibility, may be subject to disciplinary procedure.

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61. Disabled Children. Upon entry on duty or birth of a child, birth certificate, national identity card or national passport of child giving full name, date of birth and nationality.

62. If the staff member is claiming special dependency allowance, a medical report must be forwarded to the UN Medical Director for determination of disability through:

a) if internationally-recruited staff members stationed outside NY, the local Human Resources/Operations Officer and the Human Resources Officer in DHR serving the duty station;

b) if internationally-recruited staff members stationed in NY, the Senior Human Resources Officer in DHR serving NY;

c) if locally-recruited staff member stationed outside NY, the local Human Resources/Operations Officer. No documentation should be sent to DHR (see Annex D); and

d) if locally-recruited staff members stationed in NY, the Senior Human Resources Officer in DHR serving NY.

63. Usually, the UN Medical Services Division requires the staff member to periodically provide updated medical reports.

64. Stepchildren under 21. Upon entry on duty or marriage, birth certificate, national identity card or national passport of stepchild giving full name, date of birth and nationality.

65. If the staff member is claiming dependency allowance, a copy of the divorce judgement granting legal custody of child to staff member’s spouse. No further supporting documentation will be required, but he/she should have the necessary documentation ready at any time during the five-year period following payment, to clarify or to answer queries arising from a review or audit of the entitlement or related payment, i.e.:

a) evidence that the child resides with the staff member;

b) evidence that the staff member provides main and continuing support; and

c) evidence that the child is not receiving main and continuing support from other parent.

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66. Adopted Children under 21. Upon entry on duty or adoption, birth certificate, national identity card or national passport of adopted child giving full name, date of birth and nationality.

67. If the staff member is claiming dependency allowance:

a) where there is statutory provision for adoption or prescribed court procedure for official recognition of customary or de facto adoption:

 official documentary evidence of adoption in accordance with relevant statutory provisions, or formal recognition by prescribed court procedure of customary or de facto adoption of child;

 if adoption has not yet taken place, official documentary evidence that adoption procedures have been initiated and that pending finalization of procedure, child is being entrusted to staff member’s care; and

 if legally adopted child does not reside with the staff member, proof of continuing financial support; or

b) where there is no statutory provision for adoption or prescribed court procedure for official recognition of customary or de facto adoption:

 statement from the appropriate national authorities that adoption is not possible;

 affidavit that child will be residing with the staff member and he/she will assume parental duties and obligation vis-à-vis child. Once child arrives in staff member’s home, evidence that child resides with staff member and that parental relationship between natural parents and child have been severed and have been established with adoptive parent; and

 evidence of main and continuing support.

68. Secondary Dependent. Upon entry on duty or claiming dependency benefit for the first time birth certificate, national identity card or national passport of secondary dependent giving full name, date of birth and nationality.

69. No further supporting documentation will be required, but the staff member should have the necessary documentation ready at any time during the five-year period following payment of the secondary dependency allowance to clarify or to answer queries arising from a review or audit of the entitlement or related payment, i.e.:

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a) yearly notarized statements from the dependent indicating:

 that monies received from the staff member contribute to at least half or more of his/her financial support and at least twice the amount of the dependency allowance payable to the staff member in respect of secondary dependent;

 that the amount is received on a regular basis from the staff member (e.g. monthly or quarterly);

 the evidence of dependent's income for previous calendar year (pension statement or income tax return); and

 that the dependent resides with the staff member; and

b) if the dependent:

 is residing with the staff member, the notarized statements should confirm that the dependent resides with the staff member; and

 is not residing with the staff member, evidence of support (bank statements, cancelled cheques, bank drafts, or money orders duly date-stamped).

70. A staff member who at any time during the five-year period following payment of the secondary dependency allowance is requested and is unable to prove eligibility, may be subject to disciplinary procedure.

20 Dependency Allowances CF/AI/2001-003 of 29 January 2001

21 Dependency Allowances CF/AI/2001-003 of 29 January 2001

ANNEX A GROSS SALARY GS-2 STEP 1 NEW YORK GENERAL SERVICE SALARY SCALE

YEAR AMOUNT

1995 $28,357

1996 $29,152

1997 $29,095

1998 $29,636

1999 $30,088

2000 $30,713

2001 $30,997

22 Dependency Allowances CF/AI/2001-003 of 29 January 2001

23 Dependency Allowances CF/AI/2001-003 of 29 January 2001

ANNEX B DEPENDENCY STATUS FORM FOR NEW STAFF MEMBERS UNICEF 468 (01/01)

(See attached)

24 Dependency Allowances CF/AI/2001-003 of 29 January 2001

25 Dependency Allowances CF/AI/2001-003 of 29 January 2001

ANNEX C DEPENDENCY STATUS FORM FOR CHANGE IN STATUS UNICEF 469 (01/01)

(See attached)

26 Dependency Allowances CF/AI/2001-003 of 29 January 2001

27 Dependency Allowances CF/AI/2001-003 of 29 January 2001

ANNEX D SAMPLE INTER-OFFICE MEMORANDUM TO THE UN MEDICAL SERVICES DIVISION REQUESTING SPECIAL DEPENDENCY ALLOWANCE FOR A LOCALLY-RECRUITED STAFF MEMBER

INTER-OFFICE MEMORANDUM

TO: Director Date:______UN Medical Services Division D/M/Y

FROM: xxx (name) HR/Operations Officer UNICEF xxx (duty station)

SUBJECT: Request for Payment of Special Dependency Allowance

The below-mentioned locally-recruited staff member has requested a special dependency allowance in respect of his/her disabled child. In order for UNICEF to approve this allowance, we need your verification of the child's disability.

Thank you.

Staff Member's Name: ______

Staff Member's Index Number: ______

Child's Name: ______

Child's Date of Birth: ______

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