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Beneficiary Form

HROG Section:
Document Title:
DCCCD Beneficiary Form
Initial Date Posted:
Board Approval:
Applies To:
All DCCCD Employees
District Human Resources
Chancellor's Cabinet: November 17, 2009
Related TASB Policy:
Last Date Revised:


 The purpose of the DCCCD Beneficiary form is to allow the DCCCD to release employment earnings, unused vacation payments, travel reimbursements and similar types of unpaid monies owed to the employee in the event of the death of the employee.





It is the employee’s responsibility to elect a primary and/or contingent beneficiary for release of such monies. Each employee is required to document the election of a primary and/or contingent beneficiary of their choice on the DCCCD Beneficiary form. The DCCCD Beneficiary form must be completed in its entirety.

The DCCCD Beneficiary Form is required to be signed by the employee in the presence of a Notary.

An employee may change their designation of a primary and/or contingent beneficiary at their discretion which voids all previous designations submitted. The DCCCD will release unpaid monies to the most recent beneficiary on file in the Human Resources office.

Married employees may name someone other than their spouse as a beneficiary. However, payment of benefits may be delayed or disputed unless the spouse also signs the DCCCD Beneficiary Form in the space provided on the form. The signature of the spouse in this section must be completed in the presence of a Notary.

Unpaid monies for employees who do not designate a primary and/or contingent beneficiary will be handled through processes authorized by the DCCCD legal office and in coordination with DCCCD current business practices.


Payments of monies owed to a primary and/or contingent beneficiary will be made within thirty (30) business days from the receipt of a state certified death certificate and a completed W-9 federal withholding form. Payments made in multiple transactions will require only one state certified death certificate. No interest will accrue or be paid on unpaid monies.

Employee Responsibility

HR Responsibility

Exceptions To Policy

Other Notes

Related Links

Beneficiary Form (PDF - 60KB)