Submission of the requested information is mandatory. The information requested is collected
pursuant to the California Government Code (sections 20000 et seq.) and will be used for
administration of the Board’s duties under the Retirement Law, the Social Security Act, and the
Public Employees’ Medical and Hospital Care Act, as the case may be. Portions of this
information may be transferred to another governmental agency (such as your employer) but only
in strict accordance with current statutes regarding confidentiality. Failure to supply the
information may result in the System being unable to perform its functions regarding your status.
You have the right to review your membership files maintained by the System. For questions
concerning your rights under the Information Practices Act of 1977, please contact the
Information Practices Act Coordinator, CalPERS, P.O. Box 942702, Sacramento, CA 94229-
Section 7(b) of the Privacy Act of 1974 (Public Law 93-579) requires that any federal, state, or
local governmental agency which requests an individual to disclose his Social Security account
number shall inform that individual whether that disclosure is mandatory or voluntary, by which
statutory or other authority such number is solicited, and what uses will be made of it. Section
111 of Public Law 101-173 requires group health plans to collect and provide member Social
Security numbers for the coordination of federal and state benefits. Furthermore, Health Account
Services requires each enrollee’s Social Security number for identification purposes and to verify
eligibility for benefits. Specifically, the California Public Employees’ Retirement System uses
Social Security numbers for the following purposes:
1. Enrollee identification for eligibility processing and eligibility verification.
2. Payroll deduction and state contribution for state employees.
3. Billing of contracting agencies for employee and employer contributions.
4. Reports to the Public Employees’ Retirement System and other state agencies.
5. Coordination of benefits among carriers.
Enrollment in certain plans constitutes an agreement to have any issue of medical malpractice
decided by neutral arbitration and waiver of any right to a jury or court trial. Refer to the health
plan Evidence of Coverage booklet to determine if this provision is applicable to your plan.