Fillable CalPERS Special Power Of Attorney Guide (City of Riverside, California)

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CalPERS Special Power Of Attorney Guide (City of Riverside, California)

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A Guide to the
CalPERS Special Power of Attorney
This page intentionally left blank to facilitate double-sided printing.
www.calpers.ca.gov
TABLE OF CONTENTS
Introduction .............................................2
Authority Granted by Your CalPERS Special
Power of Attorney Form ..................................3
Duration of Your CalPERS Special Power of Attorney ........3
Changing Your Power of Attorney ..........................4
Revoking Your Power of Attorney ..........................4
Non-CalPERS Power of Attorney Documents ................4
Disclaimer ...............................................5
Contacting CalPERS ......................................5
CalPERS Special Power of Attorney Checklist ...............6
Special Power of Attorney Form ...........................7
Become a More Informed Member ........................ 13
CalPERS Website
..................................... 13
my|CalPERS
......................................... 13
CalPERS Education Center
.............................. 13
Experience CalPERS Through Social Media
.................. 13
Reach Us by Phone
.................................... 13
Visit Your Nearest CalPERS Regional Office
.................. 14
Privacy Notice .......................................... 15
2 888 CalPERS (or 888-225-7377)
INTRODUCTION
This publication will help you understand the CalPERS Special Power of
Attorney form and the importance of having one on file. You must complete
a power of attorney form while you are able to understand the powers you
are granting. If you become incapacitated or otherwise unable to handle
your affairs before completing a power of attorney or other estate planning
documents, CalPERS may find it necessary to withhold your retirement
allowance until a court appoints a conservator to handle your affairs.
Since appointment of a conservator can be both expensive and time-
consuming, you should consider completing the CalPERS Special Power
of Attorney form.
Powers of attorney are not all the same:
• A durable power of attorney contains a “durability clause,” which is a
provision permitting your designated attorney-in-fact to act on your behalf
even if you become incapacitated or otherwise unable to handle your affairs.
• A special or limited power of attorney grants only the powers that are
specifically stated in the power of attorney document.
• A contingent/springing power of attorney only goes into effect once
certain conditions that you specify are met. This type of power of attorney
is often designed to go into effect if you become disabled, incapacitated,
or otherwise unable to handle your affairs.
• A general (non-durable) power of attorney permits your attorney-in-fact to
act on your behalf in all of your personal affairs. It automatically terminates
when you become incapacitated unless it contains a durability clause.
• A health care power of attorney permits your attorney-in-fact to make
decisions about your health care if you are unable to do so. CalPERS
cannot accept this type of power of attorney for retirement transactions.
A special power of attorney grants only the powers that are specifically stated
in the power of attorney document. The CalPERS Special Power of Attorney
form only authorizes your attorney-in-fact to handle your CalPERS retirement
affairs. It is specifically designed for retirement matters administered by
CalPERS, the Judges’ Retirement System I and Judges’ Retirement System II,
or the Legislators’ Retirement System. Because of the broad power granted by
the CalPERS Special Power of Attorney form, we recommend that you consult
an attorney before signing this form.
With the appropriate authority, having a CalPERS Special Power of
Attorney on file with us ensures that your designated attorney-in-fact
can perform important duties concerning your CalPERS business,
such as address changes, federal or state tax withholding elections,
lost or stolen retirement checks, beneficiary designations, or retirement
benefit elections should you become unable to act on your own behalf.
However, you cannot use the CalPERS Special Power of Attorney
form to appoint an administrator of your estate before your death.
3www.calpers.ca.gov
AUTHORITY GRANTED BY YOUR CalPERS
SPECIAL POWER OF ATTORNEY FORM
You choose the specific authority given to your attorney-in-fact:
• Select a retirement payment option on your behalf. If this specific authority
is granted, your attorney-in-fact can select a payment option on your behalf.
–
If this authority is not granted, and there is a beneficiary on file, then your
attorney-in-fact may elect the Unmodified Allowance or the Return of
Remaining Contributions Option 1.
–
If this authority is not granted, and there is no beneficiary on file, then
your attorney-in-fact may only elect the Unmodified Allowance.
• Designate a beneficiary of your retirement benefits. If this specific authority
is granted, pursuant to Probate Code section 4264, your attorney-in-fact
may designate a beneficiary or change the beneficiary that you designated.
This authority includes designating himself or herself as your beneficiary
unless you specify otherwise.
–
If no beneficiary is on file at the time of your death, any retirement benefits
payable will be paid as provided in Government Code section 21493 and/
or Probate Code section 6402.
DURATION OF YOUR CalPERS SPECIAL
POWER OF ATTORNEY
You can specify when you want your CalPERS Special Power of Attorney
to commence and terminate:
• Durable – The attorney-in-fact’s authority will commence immediately
and will remain in effect for your lifetime, even if you become incapacitated,
unless you specifically revoke it. You may also continue to act on your
own behalf.
• Limited – You specify a date or event when the attorney-in-fact’s authority
will commence and terminate.
• Contingent/Springing – For the purposes of the CalPERS Special Power
of Attorney form, the attorney-in-fact’s authority will commence only upon
a determination that you are unable to handle your own retirement affairs.
You specify the name and relationship or title of the person who is authorized
to make the determination (usually a physician).
• General (non-durable) – The attorney-in-fact’s authority will terminate if
you become incapacitated. You specify the name and relationship or title of
the person who is authorized to make the determination (usually a physician).
4 888 CalPERS (or 888-225-7377)
CHANGING YOUR POWER OF ATTORNEY
If you change your mind or need to update your CalPERS Special Power
of Attorney form, you must:
• Complete a new power of attorney form with the changes you desire.
• Inform those who may have a copy of the old power of attorney form
that it is no longer valid and ask that copies of the old form be returned
to you or destroyed.
• Provide copies of the new power of attorney form to those people who
may need to carry out your wishes.
REVOKING YOUR POWER OF ATTORNEY
If you have not executed and submitted a new CalPERS Special Power of
Attorney form but wish to revoke the power of attorney that CalPERS has
on file, you must notify us in writing of your intent to revoke your power of
attorney. Your revocation will not be effective until it is provided in writing
to CalPERS. We recommend submitting a new power of attorney form to
replace the previous one.
Even if you do not specifically revoke your power of attorney, pursuant to
Probate Code section 4130(a), if you execute a new power of attorney that
is inconsistent with a previous power of attorney that CalPERS has on file,
the most recent power of attorney will control regarding the inconsistency.
If you still have questions about your power of attorney after reading this
publication, you should consult an attorney.
NON-CalPERS POWER OF ATTORNEY
DOCUMENTS
The CalPERS Special Power of Attorney form is specifically designed to
help manage CalPERS retirement issues, but we will also accept other power
of attorney documents that specifically grant the attorney-in-fact authority
to conduct business with us. If your power of attorney document does not
contain a durability clause, CalPERS will not be able to honor it if you
become incapacitated.
5www.calpers.ca.gov
DISCLAIMER
The information provided in this publication is intended to serve solely as
a guide to the CalPERS Special Power of Attorney form. It is not intended
to take the place of advice from a licensed attorney, particularly with regard
to a non-CalPERS power of attorney. If you have any questions regarding
the CalPERS Special Power of Attorney form or about your non-CalPERS
power of attorney document, please consult an attorney.
CONTACTING CalPERS
Your attorney-in-fact may only handle business on your behalf by
contacting us at our toll-free number, by written correspondence, or
by visiting a Regional Office. Your attorney-in-fact may not conduct
business by accessing your online my|CalPERS account.
6 888 CalPERS (or 888-225-7377)
C alPERS SPECIAL POWER OF ATTORNEY
CHECKLIST
For your convenience, we have provided a quick checklist to help you
understand the CalPERS Special Power of Attorney. Please consider the
truthfulness of the statements below before submitting your form to CalPERS.
c
I am of sound mind and acting of my own free will.
c
I understand that the individual I have selected as my attorney-in-fact to
make retirement-related decisions for me is at least 18 years old and may be
related to me by blood, marriage, or domestic partnership legally recognized
by the State of California.
c
I realize that my attorney-in-fact has the power and authority to transact
all matters relating to my benefits and accounts with the California Public
Employees’ Retirement System, the Judges’ Retirement System I, the Judges’
Retirement System II, and the Legislators’ Retirement System.
c
If I have designated more than one attorney-in-fact, I have indicated that
my attorneys-in-fact are to act jointly, separately, or alternately.
c
If I have designated my attorneys-in-fact to act alternately, I have numbered
them in the order in which they are to act.
c
I understand that I may authorize my attorney-in-fact to select any payment
option available under the retirement plan even though the selected option
may reduce the monthly allowance that would otherwise be paid to me
during my lifetime.
c
I understand that I may authorize my attorney-in-fact to designate or
change my beneficiary.
c
I understand that I may authorize my attorney-in-fact to designate himself
or herself as my beneficiary.
c
My attorney-in-fact has read the notice about his or her legal responsibilities
and signed the form. Attorney-in-fact signature is optional.
c
Two people who are at least 18 years old and are not my attorney-in-fact
have signed and witnessed my signature on the CalPERS Special Power
of Attorney form, or a notary public has acknowledged my signature
designating my attorney-in-fact.
c
I have notified the individual I have selected as my attorney-in-fact, and
he or she has agreed to participate.
c
If I have designated more than one attorney-in-fact, I have notified the
individuals and they have each agreed to participate.
c
I have informed my attorney-in-fact that he or she may not conduct
business by accessing my online my|CalPERS account. All contact
with CalPERS on my behalf must be made by telephone, by written
correspondence, or by visiting a Regional Office.
c
I have provided a copy of the completed power of attorney to my
attorney-in-fact and other family members who may need to carry
out my wishes.
c
I have signed and indicated the execution date on the power of
attorney form.
c
I have submitted my CalPERS Special Power of Attorney form to
CalPERS, Benefit Services Division, P.O. Box 942716, Sacramento,
California 94229-2716.
PERS-OSS-138 (12/18) Page 1 of 5
Section 2
Designation of Attorney-in-Fact (Agent)
When completing this form,
please be sure to print the
requested information.
For the purpose of this
form, a “principal” is
defined as a person who
empowers another to act
as a representative on
his or her behalf.
The “agent” is the
attorney-in-fact.
If you appoint more than
one attorney-in-fact and do
not check a box, all of your
attorneys-in-fact must act
or sign together (jointly).
*If you choose “Alternately,”
identify the order of
your attorneys-in-fact in
the boxes below.
Name of Principal (First Name, Middle Initial, Last Name) Social Security Number or CalPERS ID
Address County
City State ZIP Daytime Phone
By this document I intend to create a power of attorney by appointing the person(s) named below to make
retirement-related decisions for me as allowed by the California Probate Code. The authority granted
pursuant to this power of attorney is expressly limited to decisions relating to my financial and health
benefits under the California Public Employees’ Retirement System, the Judges’ Retirement System I or the
Judges’ Retirement System II, and the Legislators’ Retirement System, hereinafter CalPERS, JRS I, JRS II,
and LRS, respectively. I give my agent, also called an attorney-in-fact, the powers specified herein with
the understanding that these powers will be used for my benefit and will be exercised only in a fiduciary
capacity. This power does not authorize the appointed agent to make any medical decisions for me.
Section 1
Creation of Durable Power of Attorney for Retirement-Related Business
You have the option to designate one attorney-in-fact. Your attorney-in-fact must be at least 18 years
old at the time this document is executed.
If you appoint more than one attorney-in-fact, choose the jointly, separately, or alternately check box below:
c
Jointly – All designated attorneys-in-fact must sign for any action. Granting joint authority to two or
more attorneys-in-fact means that the agents’ authority is exercisable only by their unanimous action.
If one is unavailable because of absence, illness, or other temporary incapacity, the other attorneys-in-
fact may exercise their authority under the power of attorney.
c
Separately – Any one designated attorney-in-fact may act without the other(s).
c
Alternately – Your attorney-in-fact will act in the numerical order you assign in the boxes below.*
The successor attorney-in-fact will act if the person you originally appointed is unavailable because
of absence, illness, or other temporary incapacity. Delegation of powers to any third party who is not
named as an alternate attorney-in-fact is not permitted under this document.
( )
( )
( )
( )
Name of Attorney-in-Fact (First Name, Middle Initial, Last Name) Birth Date (mm/dd/yyyy) Relationship
Address Social Security Number or CalPERS ID
City State ZIP Daytime Phone
Name of Attorney-in-Fact (First Name, Middle Initial, Last Name) Birth Date (mm/dd/yyyy) Relationship
Address Social Security Number or CalPERS ID
City State ZIP Daytime Phone
Name of Attorney-in-Fact (First Name, Middle Initial, Last Name) Birth Date (mm/dd/yyyy) Relationship
Address Social Security Number or CalPERS ID
City State ZIP Daytime Phone
#
#
#
Special Power of Attorney
888 CalPERS (or 888-225-7377)
•
TTY: (877) 249-7442
PERS-OSS-138 (12/18) Page 2 of 5
You must check a box
to indicate whether
you are granting the
specific authority to your
attorney(s)-in-fact. If you
do not check a box, your
attorney(s)-in-fact will
not be granted this
specific authority.
See A Guide to the
CalPERS Special Power of
Attorney (PUB 30) for a
detailed explanation of the
authority you are granting.
Section 3
General Statement of Authority Granted
I hereby grant to my attorney-in-fact full power and authority to transact matters on my behalf relating to
CalPERS, JRS I, JRS II, or LRS. I understand that I am granting authority to the attorney-in-fact regardless
of whether that person is related to me by blood, marriage, or legal domestic partnership. By signing this
Special Power of Attorney form I intend that:
•
My attorney-in-fact (
c
is;
c
is not) authorized to select any retirement payment option available
under the retirement plan other than the Unmodified Allowance.
Note: Allowing your attorney-in-fact to choose any retirement payment option available under
the retirement plan other than the Unmodified Allowance may reduce the monthly allowance
that would otherwise be paid to you during your lifetime.
•
My attorney-in-fact (
c
is;
c
is not) authorized to designate or change my beneficiary.
Note: Allowing your attorney-in-fact to designate or change your beneficiary will also allow
your attorney-in-fact to designate himself or herself as your beneficiary unless you specify
otherwise below.
On the following lines you may give special instructions limiting the powers granted to your
attorney(s)-in-fact.
Unless I indicate otherwise, this power of attorney shall be considered effective immediately and will
continue for the duration specified below or, if no duration is specified, until my death. My attorney-in-fact
is hereby instructed to notify CalPERS in writing of my disability, incapacity, or death immediately upon
its occurrence. I understand that I may revoke this power of attorney at any time by providing CalPERS
with a written statement of my intent to do so.
c
This durable power of attorney is to commence immediately and to remain in effect for my lifetime,
even if I become incapacitated, or until I specifically revoke it.
c
This limited power of attorney is to commence on _________________ and terminate on
______________________________.
c
This contingent/springing power of attorney is to commence only upon a determination that
I am incapacitated and/or unable to handle my own affairs. The determination of whether I am
incapacitated and/or unable to handle my own affairs for the purpose of this instrument shall
be made in a written statement signed by
______________________________________________________.
c
This general (non-durable) power of attorney is to terminate in its entirety if I become incapacitated.
The determination that I am incapacitated and/or unable to handle my own affairs for the purpose
of this instrument shall be made in a written statement signed by
______________________________________________________.
Section 4
Duration of Power of Attorney
Please be careful in
choosing when you
want your power of
attorney to commence
and/or terminate.
Check one box to
indicate your choice.
Checking multiple boxes
may invalidate this form.
The person that you
authorize to make
the determination of
incapacity must be at least
18 years old at the time
of designation. This person
may be, but is not required
to be, a licensed
physician or attorney.
Date (mm/dd/yyyy) or Event
Name and Relationship or Title of Person Authorized to Make the Determination
Name and Relationship or Title of Person Authorized to Make the Determination
Date (mm/dd/yyyy) or Event
Put your name and Social
Security number or CalPERS ID
at the top of every page
Name of Member Social Security Number or CalPERS ID
PERS-OSS-138 (12/18) Page 3 of 5
The authority granted by the CalPERS Special Power of Attorney form is limited to matters relating
to CalPERS, JRS I, JRS II, and LRS. The person designated as your attorney-in-fact does not have any
authority over your other real and/or personal property. If you wish that your attorney-in-fact have authority
over your real and/or personal property, it is recommended that you seek legal counsel.
You may notice that the language contained in the following Warning Statements refers to more
extensive authority than granted by the CalPERS Special Power of Attorney form. These Warning
Statements are required by Probate Code section 4128 and must be included in all preprinted
durable power of attorney forms even though the CalPERS Special Power of Attorney form does
not authorize your attorney-in-fact to do many of the things mentioned in the Warning Statements.
If you are concerned with the Warning Statements or the extent of the authority being granted by
the CalPERS Special Power of Attorney form, we again recommend that you seek legal counsel.
(Warning): Notice to Person Executing Durable Power of Attorney
A durable power of attorney is an important legal document. By signing a durable power of attorney,
you are authorizing another person to act for you, the principal. Before you sign this durable power
of attorney, you should know these important facts:
•
Your agent (attorney-in-fact) has no duty to act unless you and your agent agree otherwise
in writing.
•
This document gives your agent the powers to manage, dispose of, sell, and convey your real and
personal property, and to use your property as security if your agent borrows money on your behalf.
This document does not give your agent the power to accept or receive any of your property, in
trust or otherwise, as a gift, unless you specifically authorize the agent to accept or receive a gift.
•
Your agent will have the right to receive reasonable payment for services provided under this
durable power of attorney unless you state otherwise in this power of attorney.
•
The powers you give your agent will continue to exist for your entire lifetime, unless you state
that the durable power of attorney will last for a shorter period of time or unless you otherwise
terminate the durable power of attorney. The powers you give your agent in this durable power
of attorney will continue to exist even if you can no longer make your own decisions regarding
the management of your property.
•
You can amend or change this durable power of attorney only by executing a new durable power
of attorney or by executing an amendment through the same formalities as an original. You have
the right to revoke or terminate this power of attorney at any time as long as you are competent.
•
This durable power of attorney must be dated and must be acknowledged before a notary
public or signed by two witnesses. If it is signed by two witnesses, they must witness either
(1) the principal’s signing of the power of attorney or (2) the principal’s acknowledgement of his
or her signature. A durable power of attorney that may affect real property should be acknowledged
before a notary public so that it can easily be recorded.
•
You should read this durable power of attorney carefully. When effective, this durable power of
attorney will give your agent the right to deal with property that you now have or might acquire
in the future. This durable power of attorney is important to you. If you do not understand the
durable power of attorney or any provision of it, you should obtain the assistance of an attorney
or other qualified person.
Section 5
Warning Statements
Attorney(s)-in-fact may
not conduct business by
accessing your online
my|CalPERS account.
All contact with CalPERS
on your behalf must be
made by telephone, by
written correspondence,
or by visiting a
Regional Office.
The “agent” is the
attorney-in-fact.
Put your name and Social
Security number or CalPERS ID
at the top of every page
Name of Member Social Security Number or CalPERS ID
PERS-OSS-138 (12/18) Page 4 of 5
Section 6
Principal’s Acknowledgement and Execution
I am of sound mind and have consulted with an attorney or otherwise understand my elections. I am
executing this legal document under my own free will. I agree that any third party who receives a copy
of this document may act under it. Revocation of the power of attorney is not effective as to a third party
until the third party has actual knowledge of the revocation.
Date Executed (mm/dd/yyyy) City State
Signature of Principal County
Print Name of Principal (First Name, Middle Initial, Last Name) Social Security Number or CalPERS ID
To be completed and
signed by the principal.
Signature of the agent
(attorney-in-fact)
is optional.
(Warning): Notice to Person Accepting the Appointment as Attorney-in-Fact
By acting or agreeing to act as the agent (attorney-in-fact) under this power of attorney you assume
the fiduciary and other legal responsibilities of an agent. These responsibilities include:
•
The legal duty to act solely in the interest of the principal and to avoid conflicts of interest.
•
The legal duty to keep the principal’s property separate and distinct from any other property
owned or controlled by you.
You may not transfer the principal’s property to yourself without full and adequate consideration or
accept a gift of the principal’s property unless this power of attorney specifically authorized you to
transfer property to yourself or accept a gift of the principal’s property. If you transfer the principal’s
property to yourself without specific authorization in the power of attorney, you may be prosecuted
for fraud and/or embezzlement. If the principal is 65 years of age or older at the time the property
is transferred to you without authority, you may also be prosecuted for elder abuse under Penal
Code section 368. In addition to criminal prosecution, you may also be sued in civil court.
I have read the foregoing notice and I understand the legal and fiduciary duties that I assume by
acting or agreeing to act as the agent (attorney-in-fact) under the terms of this power of attorney.
Lastly, the principal’s benefit shall not be subject to execution, process, or assignment under California
Public Employees’ Retirement Law section 21255.
Print Name of Agent (First Name, Middle Initial, Last Name)
Signature of Agent Date (mm/dd/yyyy)
Print Name of Agent (First Name, Middle Initial, Last Name)
Signature of Agent Date (mm/dd/yyyy)
Print Name of Agent (First Name, Middle Initial, Last Name)
Signature of Agent Date (mm/dd/yyyy)
Section 5, continued
Warning Statements, Continued
Put your name and Social
Security number or CalPERS ID
at the top of every page
Name of Member Social Security Number or CalPERS ID
Mail to:
CalPERS Benefit Services Division • P.O. Box 942716, Sacramento, California 94229-2716
PERS-OSS-138 (12/18) Page 5 of 5
Section 7
Witness Information
Must be completed by
a notary public if Section 7
is not completed.
CalPERS images these
documents. Please be
advised embossed seals
may not appear when this
document is reviewed. An
inked stamp is preferred.
Notary
State County
On _______________ before me ____________________________________, personally appeared
____________________________________, who proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to
me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/
their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted,
executed the instrument. I certify under Penalty of Perjury under the laws of the State of California that
the foregoing paragraph is true and correct.
Witness my hand and official seal.
Signature of Notary Public Notary Seal
Print Name
Printed Name of Notary PublicDate (mm/dd/yyyy)
Name of Principal
I have witnessed the principal’s signature or the principal’s acknowledgment of his or her signature
designating power of attorney. I am of sound mind, I am an adult at least 18 years old, and I am not the
attorney-in-fact or successor attorney-in-fact. My signature certifies that the principal is known to me
and is the same person who signed and dated this Special Power of Attorney form.
Signature of Witness 1 Print Name of Witness 1 (First Name, Middle Initial, Last Name)
Address Date (mm/dd/yyyy)
City State ZIP
Signature of Witness 2 Print Name of Witness 2 (First Name, Middle Initial, Last Name)
Address Date (mm/dd/yyyy)
City State ZIP
Section 8
Notary Public Acknowledgement
Must be completed by
two individuals who are
at least 18 years of
age and are not named
as attorney-in-fact or
successor attorney-in-fact.
Alternately, Section 8
below must be completed
by a notary public.
A notary public or other officer completing this certificate verifies only the identity of the individual
who signed the document to which this certificate is attached, and not the truthfulness, accuracy,
or validity of that document.
Put your name and Social
Security number or CalPERS ID
at the top of every page
Name of Member Social Security Number or CalPERS ID
This page intentionally left blank to facilitate double-sided printing.
13www.calpers.ca.gov
BECOME A MORE INFORMED MEMBER
CalPERS Website
Visit www.calpers.ca.gov for information on all our benefits and services.
You can also sign up to receive email newsletters and alerts.
my|CalPERS
Log in at my.calpers.ca.gov
to access real-time details and balances of your
CalPERS accounts. With my|CalPERS you can:
• View, print, and save current and past statements.
• Select mailing preferences for your statements, newsletters, and retirement checks.
• Search for medical premium rates and health plans available in your area
and confirm which dependents are covered on your health plan.
• Estimate your future retirement benefit and save estimates to view later.
• Send and receive secure messages.
• Order and download publications.
• Send account information to third parties, such as banks.
• Apply for service retirement.
• Change your beneficiary designation.
• Retirees can update contact information, set up direct deposit, change tax
withholdings, and view annual tax statements.
CalPERS Education Center
Whether you’re in the early stages of your career or getting ready to retire,
visit the CalPERS Education Center in my|CalPERS to:
• Take online classes that help you have a better understanding of your
CalPERS benefits.
• Register for instructor-led classes and download class materials.
• Register to attend a CalPERS Benefits Education Event at a location near you.
• Schedule a one-on-one appointment with a representative at your nearest
CalPERS Regional Office.
Experience CalPERS Through Social Media
Facebook: www.facebook.com/myCalPERS
Twitter: www.twitter.com/CalPERS
Instagram: www.instagram.com/CalPERS
YouTube: www.youtube.com/CalPERS
LinkedIn: www.linkedin.com/company/CalPERS
Reach Us by Phone
Call us toll free at 888 CalPERS (or 888-225-7377).
Monday through Friday, 8:00 a.m. to 5:00 p.m.
TTY: (877) 249-7442
14 888 CalPERS (or 888-225-7377)
Visit Your Nearest CalPERS Regional Office
Fresno Regional Office
10 River Park Place East, Suite 230
Fresno, CA 93720
Glendale Regional Office
Glendale Plaza
655 North Central Avenue, Suite 1400
Glendale, CA 91203
Orange Regional Office
500 North State College Boulevard, Suite 750
Orange, CA 92868
Sacramento Regional Office
Lincoln Plaza East
400 Q Street, Room 1820
Sacramento, CA 95811
San Bernardino Regional Office
650 East Hospitality Lane, Suite 330
San Bernardino, CA 92408
San Diego Regional Office
7676 Hazard Center Drive, Suite 350
San Diego, CA 92108
San Jose Regional Office
181 Metro Drive, Suite 520
San Jose, CA 95110
Walnut Creek Regional Office
Pacific Plaza
1340 Treat Boulevard, Suite 200
Walnut Creek, CA 94597
Visit the CalPERS website for directions to your local office.
Regional Office hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.
15www.calpers.ca.gov
PRIVACY NOTICE
The privacy of personal information is of the utmost importance to
CalPERS. The following information is provided to you in compliance with
the Information Practices Act of 1977 and the Federal Privacy Act of 1974.
Information Purpose
The information requested is collected pursuant to the Government Code
(sections 20000 et seq.) and will be used for administration of Board duties
under the Retirement Law, the Social Security Act, and the Public Employees’
Medical and Hospital Care Act, as the case may be. Submission of the requested
information is mandatory. Failure to comply may result in CalPERS being
unable to perform its functions regarding your status. Please do not include
information that is not requested.
Social Security Numbers
Social Security numbers are collected on a mandatory and voluntary basis.
If this is CalPERS’ first request for disclosure of your Social Security number,
then disclosure is mandatory. If your Social Security number has already been
provided, disclosure is voluntary. Due to the use of Social Security numbers by
other agencies for identification purposes, we may be unable to verify eligibility
for benefits without the number.
Social Security numbers are used for the following purposes:
1. Enrollee identification
2. Payroll deduction/state contributions
3. Billing of contracting agencies for employee/employer contributions
4. Reports to CalPERS and other state agencies
5. Coordination of benefits among carriers
6. Resolving member appeals, complaints, or grievances with health plan carriers
Information Disclosure
Portions of this information may be transferred to other state agencies (such as
your employer), physicians, and insurance carriers, but only in strict accordance
with current statutes regarding confidentiality.
Your Rights
You have the right to review your membership files maintained by the System.
For questions about this notice, our Privacy Policy, or your rights, please write
to the CalPERS Privacy Officer at 400 Q Street, Sacramento, CA 95811 or
call us at 888 CalPERS (or 888-225-7377).
CalPERS is governed by the Public Employees’ Retirement Law and the Alternate
Retirement Program provisions in the Government Code, together referred to as the
Retirement Law. The statements in this publication are general. The Retirement
Law is complex and subject to change. If there is a conflict between the law and this
publication, any decisions will be based on the law and not this publication. If you
have a question that is not answered by this general description, you may make a
written request for advice regarding your specific situation directly to the CalPERS
Privacy Officer at 400 Q Street, Sacramento, CA 95811.
2019.2.1
California Public Employees’ Retirement System
400 Q Street
P.O. Box 942701
Sacramento, CA 94229-2701
888 CalPERS (or 888-225-7377)
www.calpers.ca.gov
PUB 30
February 2019
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CalPERS Special Power Of Attorney Guide (City of Riverside, California)

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