Form RS6370 "Electronic Funds Transfer Direct Deposit Enrollment Application" - New York

What Is Form RS6370?

This is a legal form that was released by the Office of the New York State Comptroller - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2019;
  • The latest edition provided by the Office of the New York State Comptroller;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form RS6370 by clicking the link below or browse more documents and templates provided by the Office of the New York State Comptroller.

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Download Form RS6370 "Electronic Funds Transfer Direct Deposit Enrollment Application" - New York

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Electronic Funds Transfer
Received Date
Direct Deposit
Enrollment Application
RS 6370
Please type or print clearly
in blue or black ink
(Rev.12/19)
Retirement System
[check one]
NYSLRS ID
Social Security Number
[last 4 digits]
Employees’ Retirement System (ERS)
XXX-XX-
Police and Fire’ Retirement System (PFRS)
See Reverse side for Information and Instructions
SECTION 1: TO BE REVIEWED AND CORRECTED BY PENSIONER:
Name: (First, Middle Initial, Last)
Preferred Telephone Number: (Please Provide)
Address: (Including Street, City, State and Zip Code)
Corrections: (If Any)
Please indicate the type(s) of payments you are receiving from this system:
Retiree
Beneficiary of a retiree
Alternate payee under a Domestic Relations Order
Please ensure that you have checked the proper box or boxes for the funds that you wish to have deposited to this bank account.
Note, if you do not select any of these boxes we will deposit all funds paid by us to this new EFT account.
SECTION 2: T O BE COMPLETED BY PENSIONER:
I hereby request all future benefits which become payable to me from the New York State and Local Retirement Systems (NYSLRS) be
transferred to my account via Electronic Funds Transfer (EFT) Direct Deposit to:
Account Type:
Checking (attach voided check to Section 3, or have Section 3 completed by your Financial Institution)
If your checks do not have your name imprinted on them, Section 3 MUST be completed by the
Financial Institution.
Savings- Section 3 MUST be completed by the Financial Institution.
NYSLRS is authorized to continue making such benefit payments to said financial institution or any of its successors until NYSLRS
receives written notice from me t o the contrary. I agree that NYSLRS shall have no liability or responsibility for loss occasioned
by erroneous information supplied by myself, my duly authorized representative or the financial institution.
I expressly acknowledge and understand any payments made pursuant to this request will be strictly an accommodation made to me by
NYSLRS, and NYSLRS reserves the right to discontinue or decline to honor this EFT request without prior notice.
I hereby authorize and direct the financial institution, on my behalf, my joint account holder, if any, and my estate to charge my account
for amounts paid to which I was not entitled. I also agree, on behalf of myself, my joint account holder, if any, and my estate, that such
amounts will be returned to NYSLRS.
By making this request, I hereby represent the account identified herein (and as may later be modified) is not a trust.
Signature: _____________________________________________________
Date: ____________________________________
Signature of Joint Holder: (if any) ___________________________________
Date: ____________________________________
SECTION 3: TO BE COMPLETED BY YOUR FINANCIAL INSTITUTION IF DIRECTING FUNDS INTO A SAVINGS ACCOUNT OR IF
A VOIDED CHECK IS NOT ATTACHED. THE ABOVE PENSIONER’S NAME MUST APPEAR ON THE ACCOUNT.
Name of Account: (Full Title of Account)
(Verify Account Type in Section 2 is correct)
Transit/ABA Number: (ACH Format-9 Digits)
Depositor’s Account Number: (EFT Format – Cannot Exceed 17 Digits)
Name of Financial Institution: __________________________________________________________________________________
Address: _________________________________________ Telephone Number: (________) __________ - __________________
City: _____________________________________________ State: ______________________ Zip Code: _______ - _________
I, as a representative of the above named financial institution, agree to abide by the NACHA Rules and Regulations. Amounts paid to
account holder to which he/she is not entitled will be returned to NYSLRS. Liability shall be limited as prescribed in the NACHA Rules
and Regulations.
Bank Officer Signature: __________________________________ Bank Officer: (Please Print) _____________________________
RS 6370 (Rev. 12/19)
(Page 1 of 2)
*12/19RS6370*
Electronic Funds Transfer
Received Date
Direct Deposit
Enrollment Application
RS 6370
Please type or print clearly
in blue or black ink
(Rev.12/19)
Retirement System
[check one]
NYSLRS ID
Social Security Number
[last 4 digits]
Employees’ Retirement System (ERS)
XXX-XX-
Police and Fire’ Retirement System (PFRS)
See Reverse side for Information and Instructions
SECTION 1: TO BE REVIEWED AND CORRECTED BY PENSIONER:
Name: (First, Middle Initial, Last)
Preferred Telephone Number: (Please Provide)
Address: (Including Street, City, State and Zip Code)
Corrections: (If Any)
Please indicate the type(s) of payments you are receiving from this system:
Retiree
Beneficiary of a retiree
Alternate payee under a Domestic Relations Order
Please ensure that you have checked the proper box or boxes for the funds that you wish to have deposited to this bank account.
Note, if you do not select any of these boxes we will deposit all funds paid by us to this new EFT account.
SECTION 2: T O BE COMPLETED BY PENSIONER:
I hereby request all future benefits which become payable to me from the New York State and Local Retirement Systems (NYSLRS) be
transferred to my account via Electronic Funds Transfer (EFT) Direct Deposit to:
Account Type:
Checking (attach voided check to Section 3, or have Section 3 completed by your Financial Institution)
If your checks do not have your name imprinted on them, Section 3 MUST be completed by the
Financial Institution.
Savings- Section 3 MUST be completed by the Financial Institution.
NYSLRS is authorized to continue making such benefit payments to said financial institution or any of its successors until NYSLRS
receives written notice from me t o the contrary. I agree that NYSLRS shall have no liability or responsibility for loss occasioned
by erroneous information supplied by myself, my duly authorized representative or the financial institution.
I expressly acknowledge and understand any payments made pursuant to this request will be strictly an accommodation made to me by
NYSLRS, and NYSLRS reserves the right to discontinue or decline to honor this EFT request without prior notice.
I hereby authorize and direct the financial institution, on my behalf, my joint account holder, if any, and my estate to charge my account
for amounts paid to which I was not entitled. I also agree, on behalf of myself, my joint account holder, if any, and my estate, that such
amounts will be returned to NYSLRS.
By making this request, I hereby represent the account identified herein (and as may later be modified) is not a trust.
Signature: _____________________________________________________
Date: ____________________________________
Signature of Joint Holder: (if any) ___________________________________
Date: ____________________________________
SECTION 3: TO BE COMPLETED BY YOUR FINANCIAL INSTITUTION IF DIRECTING FUNDS INTO A SAVINGS ACCOUNT OR IF
A VOIDED CHECK IS NOT ATTACHED. THE ABOVE PENSIONER’S NAME MUST APPEAR ON THE ACCOUNT.
Name of Account: (Full Title of Account)
(Verify Account Type in Section 2 is correct)
Transit/ABA Number: (ACH Format-9 Digits)
Depositor’s Account Number: (EFT Format – Cannot Exceed 17 Digits)
Name of Financial Institution: __________________________________________________________________________________
Address: _________________________________________ Telephone Number: (________) __________ - __________________
City: _____________________________________________ State: ______________________ Zip Code: _______ - _________
I, as a representative of the above named financial institution, agree to abide by the NACHA Rules and Regulations. Amounts paid to
account holder to which he/she is not entitled will be returned to NYSLRS. Liability shall be limited as prescribed in the NACHA Rules
and Regulations.
Bank Officer Signature: __________________________________ Bank Officer: (Please Print) _____________________________
RS 6370 (Rev. 12/19)
(Page 1 of 2)
*12/19RS6370*
PLEASE READ CAREFULLY
Enrollment Application:
NYSLRS provides direct deposit through the National Automated Clearing House Association (NACHA) Network which facilitates batch
payment processing within the U.S. to domestic U.S. financial institutions. We do not transfer funds into international accounts across
national borders.
NYSLRS will not make a direct deposit of a monthly pension payment into a trust account or any trust-like entity (i.e. Payable on Death
Account). Section 110 of the Retirement and Social Security Law provides that the right of a person to a pension shall be unassignable. A
trust, living or otherwise, is a separate legal entity that holds property or assets. Accordingly, the direct deposit of your pension benefit
into a trust account would constitute an impermissible assignment under the law.
NYSLRS will not make direct deposit of a monthly pension payment to a pre-paid debit card. Since there is no personal bank account
created and personally held by you when using a prepaid debit card, this too would be considered an impermissible assignment of
benefits, not allowed by law.
The Electronic Funds Transfer Direct Deposit Enrollment Application must be signed by you and the joint account holder if any. Review
Section 1 and make any necessary corrections and complete Section 2. If you are requesting direct deposit to a "Checking Account",
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. If requesting direct deposit to a "Savings Account", Section 3 must
be completed by your financial institution. Return the application to NYSLRS.
Pensioner and Joint Account Holder Authorization for Recovery of Funds Deposited in Error:
By signing this Electronic Funds Transfer Direct Deposit Enrollment Application, both for yourself and your estate, and each joint account
holder, if any, you 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 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 account 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 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
Or you may fax the completed form and any attachments to (518) 473-5323.
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.
New York State Personal Privacy Law Notification:
The New York State and Local Retirement System (NYSLRS) requests personal information on this form to operate the
NYSLRS/Electronic Funds Transfer Program. This information is being requested pursuant to State Finance Law 200(4) and Part 102 of
Title 2 of the New York Codes, Rules and Regulations. The information will be provided to the designated financial institution(s) and/or
their agent(s) for the purpose of processing payments, and for other official business of NYSLRS. No further disclosure of this information
will be made unless such disclosure is authorized or required by law. A retiree's failure to provide the requested information may delay or
prevent the receipt of payments through the Direct Deposit/Electronic Funds Transfer Program. The information provided will be
maintained in NYSLRS under the direction of the Pensioner Services Section of the Benefit Calculation and Disbursement Services
Bureau
RS 6370 (Rev. 12/19)
(Page 2 of 2)
Page of 2