Important: This document is only to be used in response to a request from DCRB to complete the information. The intent of the form is to confirm that the annuitant is receiving a monthly annuity amount and requires that the form be signed in the presence of a Notary Public.
Requests to third parties to verify monthly income require the Authorization for Release of Confidential Information form to be completed.
You can send the completed form and any required attachments by fax to (202) 566 -5001 or by mailing your documents to:
DC Retirement Board
Member Services Center
900 7th Street, NW, Second Floor
Washington, DC 20001
If you have further questions, please contact the DCRB Member Services Center by clicking on the Ask Member Services link, or by phone at (202) 343-3272 Monday – Friday from 8:30 am to 5:00 pm.
