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Visio-Verification of Depositvsd - psers state pa 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. In Section A, enter your Member Information. Fill in your name, Social Security Number, mailing address, city, state, zip code, and contact phone number.
  3. Proceed to Section B for Requestor Information. Provide the name of the institution or person requesting information, along with their contact person's name (if applicable), mailing address, city, state, zip code, and phone number.
  4. In Section C, sign and date the form to authorize the release of your account information. Ensure you print your name and provide a contact phone number.
  5. Sections D and E will be completed by a PSERS Representative. Make sure all your information is accurate before submission.

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PSERS Verification of Deposit

Member must complete Sections A, B, and C. A PSERS Representative will complete Sections D and E. If you wish for PSERS to fax.

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