Psers Forms Form PDF Details

Understanding the intricacies of the Pennsylvania Public School Employees' Retirement System (PSERS) direct deposit authorization form is crucial for any beneficiary navigating their pension logistics. With its headquarters nestled in Harrisburg, PA, and a toll-free line facilitating easy access, PSERS offers a streamlined process for managing the direct transfer of monthly benefits into retirees or their survivors' bank accounts. This form, referenced as PSRS-116, requires detailed inputs from the payee, such as name, social security number, and specific details about the pension account(s) affected, highlighting a meticulous approach to ensure accuracy in benefit distribution. The form encapsulates a comprehensive agreement between the payee and PSERS, detailing the authorization of electronic deposits to a designated financial institution, a clause for the return of funds credited after a payee's demise, and provisions for modifications or cancellation of this authorization. Such clarity and precision underscore the form's significance in safeguarding the financial integrity of retirement benefits, ensuring a seamless transaction experience for Pennsylvania's retired public school employees.

QuestionAnswer
Form NamePsers Forms Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesget the psers forms for authorization for direct deposit form psrs 116 2015 2020, psers forms print, psrs 116 form, psers on line direct deposit form

Form Preview Example

Commonwealth of Pennsylvania - Public School Employees' Retirement System

5 N 5th Street

Harrisburg PA 17101-1905 Toll-free: 1.888.773.7748 www.psers.state.pa.us Fax: 717.772.3860 PSRS-116 (03/2015)

Authorization for Direct Deposit – Electronic Transfer of Monthly Benefit

Mail Center

Instructions: The payee must complete this form. All entries must be typed or legibly printed in black ink.

Payee Name

Social Security No.

Gender

Date of Birth

Former Last Name

(only if used in this system)

Which monthly pension account(s) does this affect? (check all appropriate box(es))

 

My retirement benefit

Benefit I receive as a survivor annuitant

Divorce Benefit

Payee Agreement: I hereby authorize and request the Pennsylvania Public School Employees' Retirement System (PSERS) to direct the net amount of my monthly benefit for electronic deposit to the financial institution and account number indicated below. This authorization is not an assignment of my right to receive payment from PSERS. This form supersedes all previous electronic transfer requests and revokes all prior payment arrangements I may have made with PSERS. In the event of my death, the financial institution shall refund to PSERS any payments that were credited after the date of death and which were not legally payable, as determined by PSERS.

The authorization will remain in effect until I give written notice of its termination to PSERS in such time and in such manner as to allow PSERS a reasonable opportunity to act upon it. I agree to notify PSERS if I wish to change the designated financial institution or account to which my net pay is to be deposited sixty (60) days prior to the effective date of such change. I understand the financial organization reserves the right to cancel this agreement by notice to me.

Payee’s Signature (required)

Date Signed

Depositor Account Number

Name of Financial Institution

 

Area Code/Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address of Financial Institution

City

 

State

 

Zip Code

(Optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Routing Number

 

Account Type to be Credited (check one)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Checking

Savings

NOTE: Routing number should be the first 9 digits of the number at the bottom left on your check. See example for location of Routing Number and Depositor Account Number.

If you are unsure which numbers to use, please contact your financial institution to clarify the appropriate information.

Authorization for Direct Deposit - Electronic Transfer of Monthly Benefit

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