TR-0208 (Rev. 6/12) RDA-413
Member
Information
Change
Tennessee Consolidated Retirement System
502 Deaderick Street
Nashville, Tennessee 37243-0201
1-800-770-8277 http//tcrs/tn.gov
Please complete this form to change your member information. Section 1 should include information that is
currently on fi le with the Tennessee Consolidated Retirement System (TCRS). Select one of the following:
Active Member (You are currently employed by a covered TCRS employer.)
Inactive Member (You are not currently employed by a covered TCRS employer.)
Retiree (You are currently receiving monthly benefi ts from TCRS.)
SECTION 1. MEMBER INFORMATION
Member ID Last 4 SSN XXX-XX- Date of Birth
Full Name
Email Phone Number
SECTION 2. ADDRESS CHANGE INFORMATION (Complete only if your address has changed.)
Previous Mailing Address
City State Zip Code
New Mailing Address
City State Zip Code
SECTION 3. NAME CHANGE INFORMATION (Complete only if your name has changed.)
If you are changing your name, you must provide legal documentation of the name change (marriage certifi cate,
divorce decree or other legal documentation).
Previous Last Name First Name Middle Initial
New Last Name First Name Middle Initial
SECTION 4. CONTACT INFORMATION (Complete only if your contact information has changed.)
Previous Email Address New Email Address
Previous Phone Number New Phone Number
SECTION 5. OTHER INFORMATION CHANGE
(Complete only if your SSN or Date of Birth should be changed.)
You must provide legal documentation containing your corrected SSN or date of birth (Social Security card, birth
certifi cate, etc.).
Previous SSN Corrected SSN
Previous Date of Birth Corrected Date of Birth
This form must be signed before it can be processed. If the member is unable to sign, the endorser must enclose
a copy of his/her authorization of guardianship, power of attorney or conservatorship.
Member’s Signature Date
