Direct Deposit Authorization Calpers Form PDF Details

Ensuring an efficient and secure way to receive retirement benefits, the Direct Deposit Authorization CalPERS form stands as a crucial tool for recipients of retirement funds from the California Public Employees' Retirement System (CalPERS). This essential document, requiring thorough completion for each type of retirement benefit an individual wishes to have directly deposited, serves to streamline the transfer of funds into a designated account, whether checking or savings. The form delves into specific details, including the recipient's personal information and the intricacies of the designated bank account. It is imperative for financial institutions to fill out part of the form if the payment is directed toward a savings account or in the absence of pre-printed, personalized checks. Additionally, it outlines the process for individuals seeking to arrange direct deposits into a trust account, for which a distinct CalPERS trust form is necessary. Adherence to contemporary NACHA regulations is another critical aspect, disallowing direct deposits to financial institutions outside the territorial jurisdiction of the United States. This stipulation ensures that, in such cases, recipients receive their benefits via paper check. Beyond financial arrangements, this form simultaneously offers recipients a choice in how they receive their statements—either digitally through CalPERS' website or the traditional mail route. The process finalizes with the recipient's certification of entitlement to the payments and authorization for direct deposit, confirming the legitimacy and approved direction of their retirement benefits.

QuestionAnswer
Form NameDirect Deposit Authorization Calpers Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesCalifornia, CalPERS, calpers forms for direct deposit changes, calpers direct deposit dates 2019

Form Preview Example

 

 

 

Direct Deposit Authorization

 

 

 

888 CalPERS (or 888-225-7377) •฀TTY: (877) 249-7442 •฀Fax: (800) 959-6545

 

 

 

 

Section 1

 

Information About You

 

A separate form must

You will receive a confirmation letter with the effective date once CalPERS has processed this completed form. You

be completed for each type of

can review your statement online or receive it by mail from the California State Controller’s Office. In order to receive

retirement benefit to be sent

important information about benefits, payees should keep CalPERS informed of any address changes.

 

by Direct Deposit.

 

Name (First Name, Middle Initial, Last Name)Social Security Number or CalPERS ID

 

 

(

)

 

 

Address

 

 

Daytime Phone

 

 

 

 

 

 

 

 

 

 

City

State

 

ZIP Code

 

Section 2

If you are authorizing your payment to your savings account or do not have pre-printed, personalized checks, please have your financial institution complete this section.

*Trust Accounts You will need to complete a CalPERS trust form, which can be obtained by contacting CalPERS.

Information About Your Account

c Checking c Savings c Individual

c Joint (If so, Complete Section 3) c Trust Account *

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Routing Number (nine digits)

Account Number

Please use tape to attach your voided, pre-printed personalized check. (Do not staple or paper clip. No deposit slips.)

 

 

(

)

 

 

Name of Financial Institution

 

Branch Phone Number

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

State

ZIP Code

 

You confirm the identity of the above-named payee and the account number. As a representative of the above named financial institution, you certify the financial institution agrees to receive and deposit the payment identified above.

 

 

Signature of Representative

Print Representative’s Name

Date (mm/dd/yyyy)

 

 

 

 

 

 

 

Section 3

Information About Joint Account Holder (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

Social Security Number or CalPERS ID

 

 

 

(

)

 

 

 

 

 

 

 

 

Address

 

Daytime Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

State

ZIP Code

PERS-BSD-1199P (11/11)

Page 1 of 2

Put your name and Social

 

 

Security number or CalPERS ID

 

 

at the top of every page

Your Name

Social Security Number or CalPERS ID

 

 

Section 4

Signature required.

**To comply with new NACHA regulations regarding international ACH Transactions (IAT), CalPERS will not accept requests for

electronic fund transfers (EFT) in association with financial institutions outside of the territorial jurisdiction of the United States. (The territorial jurisdiction of the United States includes all 50 states, U.S. territories, U.S. military bases and U.S. embassies in foreign countries.) If your entire benefit allowance will be received by a financial institution outside the territorial jurisdiction of the U.S., you will be issued a

paper check in lieu of the EFT.

Direct Deposit statements are available online.

***Don’t have a Username? Register online at

my.calpers.ca.gov.

Certification

I certify I am entitled to the payment identified above. In signing this form, I authorize my payment to be sent to my financial institution and deposited to my designated account. I authorize amounts transferred after my death

or transmitted in error to be debited from my account. Additionally, I certify that the funds received are not deposited to an account that is subject to being transferred to a foreign financial institution.**

Signature of Payee

Date (mm/dd/yyyy)

cI elect to view my statement online.*** or

cI elect to receive my statement by mail.

Mail to:

CalPERS Benefit Services Division • P.O. Box 942716, Sacramento, California 94229-2716

 

 

PERS-BSD-1199P (11/11)

Page 2 of 2

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2. Given that this array of fields is done, you're ready insert the essential details in You confirm the identity of the, Signature of Representative, Print Representatives Name, Date mmddyyyy, Section, Information About Joint Account, Name, Address, City, Social Security Number or CalPERS, Daytime Phone, State, and ZIP Code allowing you to go further.

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