Use this form to request a verification of your benefits under The District of Columbia Retirement Board (DCRB). Once the form has been completed and signed, it authorizes DCRB to release the benefit information to the third party indicated on the form.

Note: This form must be signed by the payee, or the payee's authorized representative. The validity of the legal relationship of the payee's authorized representative must be previously approved by DCRB. You can have the validity of your legal relationship reviewed by submitting either the DCRB Durable Power of Attorney form or the court ordered document from when the representative was legally authorized.