Electronic Funds Transfer Direct Deposit Enrollment Application Form Page 2
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Enrollment Application
The Electronic Funds Transfer Direct Deposit Enrollment Application must be signed by you and the joint
account holder if any. If you are requesting direct deposit to a “Checking Account,” review Section 1 and make
any necessary corrections, complete Section 2, then attach a voided check to Section 3. If a voided check is
not attached to Section 3, or if your checks do not have your name imprinted on them, then Section 3 must be
completed by your financial institution. Return the application to the New York State and Local Retirement System
(NYSLRS). If requesting direct deposit to a “Savings Account,” Section 3 must be completed by your financial
institution before you return the application to the NYSLRS.
Pensioner and Joint Account Holder Authorization For Recovery of Funds Deposited in Error
By signing this Electronic Funds Transfer Direct Deposit Enrollment Application, you, both for yourself and your
estate, and each joint account holder, if any, consent to allow NYSLRS, through the designated financial institution,
to debit your account in order to recover any NYSLRS benefits to which you were not entitled. This means of
recovery shall not prevent the NYSLRS from utilizing any other lawful means to retrieve NYSLRS benefit payments
to which you were not entitled.
Changing Financial Institutions and/or Accounts
You may change financial institutions and/or accounts by completing a new enrollment application. The new
enrollment application, when processed, will cancel the enrollment at the previous financial institution or your prior
account. You should, however, be aware that changing financial institutions and/or accounts could take up to
30 days to complete. We recommend that the old account not be closed until the first deposit is made to your
new account or financial institution.
Cancellation of Electronic Funds Transfer Direct Deposit
To cancel this request, written notification from you must be received by the NYSLRS at least 30 days prior to the
next payment date.
The financial institution may terminate the electronic funds transfer direct deposit agreement with a written notice
30 days in advance of the cancellation date. The financial institution cannot cancel the authorization without
notification to both you and NYSLRS.
The New York State and Local Retirement System reserves the right to discontinue or cancel this electronic funds
transfer direct deposit agreement at any time. Written notice will be provided to you.
The completed applications should be returned to the following address:
EFT/Pensioner Services
New York State and Local Retirement System
110 State Street
Albany, New York 12244-0001
Questions or problems should be directed to the address above or you may call us at (518) 474-7736 or toll-free
at 1-866-805-0990.
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