Forms

Overview

Forms

At this time, we cannot accept electronic submission of forms due to the signature verification requirement. Verifying your signature protects the integrity of your personal account information.

Please mail completed forms to CCCERA at 1355 Willow Way, Suite 221, Concord, CA 94520. Please send original forms as we cannot accept copies. If you would like a form mailed to you, please call CCCERA at (925) 521-3960 or email info@cccera.org.

General information

Forms for Retired Members

Withholding Certificates for Pension Payments (Form 210)

Retired members have the right to change, start, or stop federal and/or state tax withholding from monthly benefit payments. A change can be made at any time by filing a new withholding authorization.

Electronic Funds Transfer (EFT) Form (Form 209)

Changes to your Electronic Funds Transfer (i.e., if you change banks or accounts) require this form.

Member Mailing Address Change Form (Form 301)

This form notifies CCCERA of changes to your mailing address.

Retiree Change of Beneficiary Designation (Form 206)

General information

Forms for Active Members

Beneficiary Designation Form (Form 102)

Please note: If you are married or a State of California registered domestic partner, by law, your beneficiary is your spouse/domestic partner, unless you have a signed, notarized, Spousal Waiver (Form 303). (California state law mandates that opposite sex domestic partners must be 62 years of age or older. See Section 3B of the Family Code (297)).

Member Mailing Address Change Form (Form 301)

If you are a County employee, you must change your address with your payroll clerk.

Request for Estimate (Form 108)

Commands