Michigan Direct Deposit Form 1Michigan Direct Deposit Form 1
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Department of Technology, Management & Budget
Office of Retirement Services
www.michigan.gov/ors

(800) 381-5111

P.O. Box 30171
Lansing MI 48909-7671

Direct Deposit Application
For Pension Recipients
NAME (LAST, FIRST, M.I.)

MEMBER ID OR SSN

DAYTIME TELEPHONE

(

)

MAILING ADDRESS

IS THIS IS A NEW ADDRESS?

CITY, STATE, ZIP CODE

I receive more than one payment from ORS
NO
If YES, I wish to have this direct deposit change apply to:
All payments to me
Other (specify)

NO

YES, please change
YES

Use this form to 1) change either the account number(s) or the financial institution(s) for your direct deposit or 2) sign up
for direct deposit if you did not choose it earlier. If you receive more than one monthly pension payment from the
Office of Retirement Services (ORS), the bank account(s) identified below will be used for ALL pension payments
unless you specify a single account in the box above.

By submitting this completed form, I authorize ORS to deposit my net monthly pension b