Personal Data Change

PERSONAL DATA CHANGE FORM

Please print legibly.

Name_________________________________________________________

Last First M.

OSU Employee ID #___________________________

Work location________________________________ Work phone________________

Home address__________________________________________________

(Paycheck will be mailed to this address if you do not have direct deposit or pay card)

City, State, Zip__________________________________________________

Home phone (_____)_______________________

Emergency Contact: Name_______________________________________

Relationship__________________________________

Phone (_____)________________________________

____________________________________________ _______________

Signature Date

Return completed form to Student Affairs Human Resources, 620 Lincoln Tower, 1800 Cannon Drive (or fax to 7-8010). Changes will be made to the Human Resources system, which will update your address for tax (W-2), paycheck and benefits purposes.

NOTE: You must contact OPERS directly, in writing, to inform the retirement system of your address change. Your letter should be addressed to Ohio Public Employees Retirement System, 277 E. Town St., Columbus, OH 43215-4642, and must include your signature and social security number. Call 1-800-222-7377 for info, or visit www.opers.org to make your changes on-line. (If you have the Alternative Retirement Plan, contact your vendor directly to make your address change.)