Have You Received A Verification Letter?
Notices mailed October 23, 2019


CCCERA recently mailed a verification of benefits form. Only a select group of retired members received this letter. If you did not receive this letter no action is needed on your part.


What is a verification audit?

CCCERA is committed to providing our members with reliable and efficient delivery of benefits. As part of our commitment to our members, CCCERA periodically performs a benefit verification audit to verify eligibility, protect our retired members, and ensure our members are actually receiving their benefits.

What address should I mail the notarized form to?

Please mail the form to:

CCCERA – Attn: Benefits

1200 Concord Avenue, Suite 300, Concord CA 94520

Faxed forms will not be accepted as original signatures are required.

If an Attorney-in-Fact or Conservator is completing my form, does it still need to be notarized?

Yes. If an attorney-in-fact or conservator is completing this form on behalf of the benefit recipient, the form still needs to be notarized. Please also enclose a copy of the document granting such authority if not previously provided to CCCERA. In addition to a copy of the member’s current government issued photo ID, a copy of the attorney-in-fact or conservator’s current government issued photo ID will also need to be returned to CCCERA.

Do I have to submit a current government-issued photo ID?

Yes. In order to verify the identity of the member, a current government-issued photo ID is required. For members living in California who are bedbound with expired identification, the California DMV offers a service where they will send a DMV Field Representative to the member’s location to process an ID card application. Interested parties should contact the California DMV at (800) 777-0133 for additional information. Out of state members should contact their local DMV to see if a similar service is offered.

Can a family member notarize the form?

No. If your form is notarized by a family member, it will not be accepted. Only a current commissioned notary public is authorized to complete the notary portion of the form.

I am disabled and unable to leave my home, how can I get the verification form notarized?

In lieu of a notarized Information Verification Form, CCCERA will accept a letter from a licensed medical doctor treating the member attesting to the fact that the member is incapable of completing the form. The letter should be returned with the completed verification form and other required documentation.

What if CCCERA does not receive my form and/or there is something missing or wrong with my form?

CCCERA staff will attempt to reach non-compliant members via mail and phone prior to any suspension of benefits. Upon compliance, the member would be entitled to receive all suspended benefits if otherwise eligible.

Note: Your benefits may be interrupted if documents are not received by the date specified.

For additional information or a duplicate form, please call CCCERA at (925) 521-3960.