Forms for Retired Members
Submit original documents only.
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. Only original forms will be accepted (no copies).
Mail completed forms to:
1200 Concord Avenue, Suite 300
Concord, CA 94520
If you would like a form mailed to you, please call CCCERA or email firstname.lastname@example.org.
Retiree Change of Beneficiary Designation (Form 206)
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)).
Electronic Funds Transfer (EFT) Form (Form 209)
Changes to your Electronic Funds Transfer (i.e., if you change banks or accounts) require this form.
IRS Form W-4P, Withholding Certificate for Periodic Pension or Annuity Payments - NEW
California State Form DE-4P, Withholding Certificate for Pension or Annuity Payments - NEW
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.
Retiree Reinstatement to Active Membership (Form 212)
Use this form to suspend your retirement and reinstate as an active CCCERA member under Gov. Code Section 31680.4.
Member Mailing Address Change Form (Form 301)
This form notifies CCCERA of changes to your mailing address.
Member Name Change Form (Form 302)
This form notifies CCCERA of a name change to apply to your account.
Release of Information Form (Form 304)
This form authorizes the release and/or use of your personal information (member records) to a person you designate. The authorization must be on file with CCCERA to be in effect and can be revoked at any time.