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Electronic Direct Deposit Authorization for Retirees

before completing this form, please read the instructions below. If you are making a change to a different bank account, do not close your old bank account until your new bank account is in effect. If you close your old bank account prior to your new account being in effect, please notify the division in writing or the funds will be returned to the State of Alaska and cause a seven to ten day delay before you receive your retirement benefit in the mail.

Please contact us by phone or email if you have any questions about the effective date of this request.

Electronic Direct Deposit Authorization for Retirees Form Instructions

Section 1

Check the appropriate box to indicate the type of authorization you are requesting.

  • Choose Start New Authorization if you are a new retiree or have not previously set up a direct deposit account for your monthly benefit.
  • Choose Change Existing Authorization if you would like to change the account number and/or financial institution of an existing account. Do not close your old account until your first payment is deposited into your newly designated account and/or financial institution.
  • Choose Cancel Existing Authorization if you would like to cancel your current direct deposit and receive your check through the U.S. Mail.

Section 2 – Member Information

  • Please check whether or not the address you are writing on this document is new.
  • Print your First Name, Middle Initial, and Last Name, as well as your Social Security Number or Retirement Identification Number (RIN).
  • Print your Mailing Address, City, State and Zip Code, as well as a Daytime Phone Number.
  • Multiple Retirement Benefits Information – Indicate which retirement benefit(s) you want affected by this change. If you are unsure how to complete this section, please contact the Retiree Payroll Section at the numbers listed at the top of the form.

Section 3 – Bank Account Information

  • Enter the Routing Number and the Account Number.
  • Indicate whether you wish to have funds deposited into either your checking or savings account. Select only one.
  • If you select Checking, attach a voided, pre-printed personalized check with your name and address in the space indicated. If you are not able to provide a voided, pre-printed personalized check you will need to bring the form to your financial institution and have them complete the Financial Institution information in the box.
  • If you select Savings, you will need to bring the form to your financial institution and have them complete the Financial Institution information in the box.

Note: Your financial institution must be a member of the Automated Clearing House Association to accept a direct deposit from DRB. DRB cannot make direct deposits to a bank or financial institution outside of the United States.

Section 4 – Applicant Certification

  • Sign your legal name as the authorizing payee or authorized legal representative. Date the form with the current date. All requested information must be completed and form must be signed to initiate an electronic deposit. Items left blank will delay processing the transfer of funds. Authorized legal representatives must have appropriate documentation on file with DRB.

Submitting the form

  • You may fax the form to the fax number listed at the top of the form.
  • You may scan and then email the form to doa.drb.payroll@alaska.gov.
  • You may mail the form to the address listed at the top of the form, attention “Retiree Payroll Section.”