Direct Deposit Authorization Calpers Form PDF Details

If you are a state or local government employee, you may be eligible for direct deposit of your pay. This means that your paychecks will be deposited directly into your bank account, instead of being issued as paper checks. You can authorize direct deposit by completing a form called the "Direct Deposit Authorization Calpers Form." In this article, we will explain how to complete the Direct Deposit Authorization Calpers Form and submit it to your employer. We will also discuss the benefits of direct deposit and some of the potential drawbacks. Finally, we will provide a link to download the form itself so that you can get started right away.

Form NameDirect Deposit Authorization Calpers Form
Form Length2 pages
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










Daytime Phone














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




























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)






















Social Security Number or CalPERS ID
















Daytime Phone





















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


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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Completing segment 1 in calpers direct deposit

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.

You confirm the identity of the, Social Security Number or CalPERS, and Section inside calpers direct deposit

3. In this particular stage, take a look at Put your name and Social Security, Your Name, Social Security Number or CalPERS, Section, Certification, Signature required, To comply with new, NACHA regulations, regarding international ACH, I certify I am entitled to the, Transactions IAT CalPERS, Signature of Payee, Date mmddyyyy, will not accept requests for, and electronic fund transfers EFT. Each one of these will have to be filled in with highest accuracy.

Part # 3 of submitting calpers direct deposit

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