Ucrs 160 Form PDF Details

Ensuring the timely and accurate delivery of monthly benefits, the UCRS 160 form serves as a crucial document for individuals associated with the University of California, facilitating the initiation, modification, or cancellation of direct deposits. This comprehensive form, which addresses a range of action items and account types, seeks to streamline the administrative process inherent in managing retirement and other benefits. Participants are required to provide detailed personal information alongside specifics concerning their preferred banking institution, including but not limited to account numbers and bank routing details. Additionally, the form mandates the inclusion of a voided check to prevent any discrepancies in financial data. Significantly, the form embeds provisions for updating mailing addresses, thereby ensuring that participants receive all pertinent communications without delay. With sections designated for both the payee and their banking institution’s acknowledgment, the process culminates in a certification and authorization segment that underscores the reciprocal commitment to accuracy and privacy. This interactive procedure not only fortifies the integrity of the direct deposit system but also reflects a concerted effort to safeguard participant benefits through meticulous record-keeping and adherence to privacy regulations as stipulated by state and federal law.

QuestionAnswer
Form NameUcrs 160 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform ucrs, direct monthly benefit online, monthly form ucrs, monthly form ucrs online

Form Preview Example

DIRECT DEPOSIT FOR MONTHLY BENEFIT

UCRS 160 (R8/12) University of California Human Resources

Send completed form to: UC Human Resources P.O. Box 24570 Oakland, CA 94623-1570

Use this form to begin, change or cancel the electronic deposit of your monthly beneit. There may be a waiting period before your direct deposit change takes effect, determined by monthly processing deadlines.

1.PERSONAL INFORMATION (Please complete entire section)

NAME (Last, First, Middle Initial)

 

SOCIAL SECURITY NUMBER

 

 

 

DAYTIME PHONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAILING ADDRESS (Number, Street)

 

 

CHANGE MY ADDRESS

BENEFIT PAYMENT TYPE (Check one)

 

 

 

 

 

 

 

YES

 

NO

 

 

UCRP

 

UC PERS VERIP

 

UC 415(m)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(City, State, ZIP, Country)

 

 

STATUS (Check all that apply)

 

 

OTHER (NON-MEMBER)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RETIRED / DISABLED

 

 

SURVIVOR / CONTINGENT ANNUITANT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. ACTION AND ACCOUNT TYPE

Action (check one):

New enrollment Cancel direct deposit

Change my account. My current account will remain open until my new account is in effect.

Change my account. I have closed my account. Send my future checks to my mailing address until my new account is in effect.

Account type for new enrollment or direct deposit change (check one):

Savings account (Complete Sections 4 and 5)

Trust account (Must be grantor-type trust; tax I.D. number must be payee’s SSN) check one box below:

Checking account (Complete Sections 3 or 4 and 5)

Trust savings account (Complete Sections 4 and 5)

 

Trust checking account (Complete Sections 3 or 4 and 5)

3. FOR COMPLETION BY PAYEE (You must attach a voided printed check. Do not attach a deposit slip.)

NAME OF FINANCIAL INSTITUTION

BRANCH NAME AND ADDRESS

(City, State, ZIP)

ACCOUNT NUMBER

BRANCH TELEPHONE NUMBER

()

4. FOR COMPLETION BY FINANCIAL INSTITUTION

NAME OF FINANCIAL INSTITUTION

ACCOUNT NUMBER (Show the number exactly as required for direct deposit.)

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BRANCH NAME AND A\DDRESS

BRANCH TELEPHONE NUMBER

BANK TRANSIT ROUTING NUMBER

I conirm the identity of the above-named payee and the account number. As a representative of the above-named inancial institution, I certify that the inancial institution agrees to receive and deposit the payment identiied above.

SIGNATURE OF REPRESENTATIVE

 

PRINT / TYPE REPRESENTATIVE’S NAME

DATE

 

 

 

 

 

 

 

 

5. CERTIFICATION AND AUTHORIZATION (Signature(s) required)

JOINT ACCOUNT HOLDER’S CERTIFICATION

 

I certify that I am entitled to the payment identiied above, and that I have read and under-

 

I certify that I have read this form. If the payee

 

stand the information and instructions on this form. In signing this form, I authorize my

 

named at left dies, I agree to refund to the

 

payments to be sent to my inancial institution and deposited to the account I have desig-

 

University any payments deposited in our

 

nated. If the account designated is a trust account, I also certify that the account tax I.D.

 

account that he or she was not entitled to receive.

 

number is my Social Security number. I authorize UC Retirement Administration to debit my

 

(Please notify UCRS of the death of the UCRS

 

account for any amounts transmitted in error or after my death. If the funds have been

 

payee.)

 

 

withdrawn following my date of death, I authorize my inancial institution to release to UC

 

 

 

 

 

 

the name and address of the person(s) responsible for withdrawing the funds. I understand

 

 

 

 

 

 

that if deposits are being made to a joint account, the other account holder must sign

 

 

 

 

 

 

the “Joint Account Holder’s Certiication” section (at right). I further agree that if the

 

 

 

 

 

 

account speciied above becomes a joint account (or if the joint account holder changes), I

 

 

 

 

 

 

must complete a new form. I understand that this authorization will remain in effect until I

 

 

 

 

 

 

cancel it by submitting a new form.

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF JOINT ACCOUNT HOLDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF PAYEE

 

 

DATE

 

DATE

 

 

FOR UC HUMAN RESOURCES USE ONLY

 

 

 

 

 

 

 

 

 

TRANSIT ROUTING NUMBER

ACCOUNT NUMBER

 

 

 

 

TRANSACTION TYPE

 

 

 

 

 

 

 

 

 

 

 

 

INPUT BY

DATE

 

AUDITED BY

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

SEE REVERSE FOR PRIVACY NOTIFICATIONS

MEMBER – PHOTOCOPY THIS FORM FOR YOUR RECORDS.

 

PRIVACY NOTIFICATIONS

STATE

The State of California Information Practices Act of 1977 (effective July 1, 1978) requires the University to provide the following information to individuals who are asked to supply information about themselves.

The principal purpose for requesting information on this form, including your Social Security number, is to verify your identity, and/or for beneits administration, and/or for federal and state income tax reporting. University policy and state and federal statutes authorize the maintenance of this information.

Furnishing all information requested on this form is mandatory. Failure to provide such information will delay or may even prevent completion of the action for which the form is being illed out. Information furnished on this form may be transmitted to the federal and state governments when required by law.

Individuals have the right to review their own records in accordance with University personnel policy and collective bargaining agreements. Information on applicable policies and agreements can be obtained from campus or Office of the President Staff and Academic Personnel Offices.

The official responsible for maintaining the information contained on this form is the Vice President—University of California Human Resources, 1111 Franklin Street, Oakland, CA 94607-5200.

FEDERAL

Pursuant to the Federal Privacy Act of 1974, you are hereby notiied that disclosure of your Social Security number is mandatory. The University’s record keeping system was established prior to January 1, 1975 under the authority of The Regents of the University of California under Article IX, Section 9 of the California Constitution. The principal uses of your Social Security number shall be for state tax and federal income tax (under Internal Revenue Code sections 6011.6051 and 6059) reporting, and/or for beneits administration, and/or to verify your identity.

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Stage number 1 of completing p ucrs 160 download

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