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ED DEPENDENT BENEFIT MEMBER: PLEASE COMPLETE ALL ITEM S. INCOMPLETE FORMS WILL BE RETURNED CAUSING A DELAY IN BENEFITS. PART A: MEMBER INFORMATION: DEPENDENT INFORMATION: Name: Social Security Number (SSN) : - - Address: Telephone : ( ) Name: Social Security Number (SSN): - - Address: Date o.

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Related content

Member Questionnaire for the Calpers Disabled...
888 CalPERS (or 888-225-7377) | TTY (877) 249-7442 ... eligibility upon receipt of this...
Learn more
Questionnarie for Disabled Dependent Benefit Form...
HBD-98 Revised 05/98. C Office of Employer and Member Health Services. P.O. Box 942714...
Learn more

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If your application is approved, you will be retired and begin receiving a monthly benefit payment from CalPERS usually within four to six weeks. CalPERS can expedite retirement processing for those who are facing a terminal illness.

The survivor and beneficiary can be the same person and often are, but don't have to be. Survivor Continuance is an employer-paid monthly benefit payable after your death in retirement to an eligible survivor.

A retired lump sum death benefit is payable to your beneficiary and amounts vary. For State of California and California State University, the amount is $2000. For public agency members, the amount is $500 to $5,000 depending on your employer's contract.

CalPERS members are eligible for various death benefits. Death benefits range from a simple return of contributions (plus interest) to a monthly allowance. Each member's death benefits can vary significantly, depending on circumstances, data, and employer contract.

One-Time Payments The Basic Death Benefit is the return of member's contributions and interest through the date of death. In some instances, there may be an additional one-time payment based on the member's earnings. Group Term Life Insurance offers a lump sum payment of $5,000.

Take a lump-sum refund or rollover. This option includes a refund of your member contributions plus interest, but not any employer contributions made on your behalf. By selecting this option, you'll end your CalPERS membership and benefits.

A one-time lump-sum death payment of $255 can be paid to the surviving spouse if they were living with the deceased. If living apart and they were receiving certain Social Security benefits on the deceased's record, they may be eligible for the lump-sum death payment.

Social Security's Lump Sum Death Payment (LSDP) is federally funded and managed by the U.S. Social Security Administration (SSA). A surviving spouse or child may receive a special lump-sum death payment of $255 if they meet certain requirements.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232