MARYLAND STATE RETIREMENT AGENCY
120 EAST BALTIMORE STREET
BALTIMORE, MARYLAND 21202-6700
DIRECT DEPOSIT — ELECTRONIC FUNDS TRANSFER SIGN-UP FORM
If you need assistance in completing this application, telephone a retirement benefits specialist at 410-625-5555 or 1-800-492-5909.
To Be Completed by Payee
To Be Completed by Financial Institution
Directions for Payee:
1) Please read the instructions printed on the following page.
2) Complete SECTION I.
3) Provide this form to your financial institution so that they may
complete Section II.
* Advise the Maryland State Retirement Agency (SRA) of
change of home address to receive important information
regarding benefits and taxes.
Directions for Financial Institution:
1) Verify information in SECTION I.
2) Complete SECTION II.
3) Send completed form to: Maryland State Retirement Agency
ATTN: EFT Department
120 East Baltimore Street
Baltimore, MD 21202-6700
or fax to: EFT Department at 410-468-1700
A. SOCIAL SECURITY