Psers Forms Form PDF Details

If you are a current or retired Pennsylvania State employee, you’ve likely had to fill out lots of PSERS forms. From retirement, benefit changes and withdrawals, there is a form necessary for every action that needs completing. Understanding what each form entails — and actually filling it out — can be difficult and time consuming. To make things easier, this blog post will provide an overview of the different types of PSERS forms so that all retirees know which documents they need to be prepared with when making any adjustments to their retirement plans.

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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Completing segment 1 of psers on line direct deposit form

2. Right after performing this step, go on to the subsequent stage and fill in the necessary particulars in all these blanks - Address of Financial Institution, City, State, Zip Code, Optional, Routing Number, Account Type to be Credited check, Checking, Savings, NOTE Routing number should be the, If you are unsure which numbers to, Authorization for Direct Deposit, and Page of.

Tips to complete psers on line direct deposit form step 2

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