Request Form - SSC - HR - Retiree Personal Data Change

This Personal Data Change form is to be used by Retirees, Survivors, and Former Employees. (HR30005)

Current Home Address - This is the physical address you are living at. (Your W-2 is mailed to this address).
Date of Birth changes require a copy of your Birth Certificate, Driver's License, or Passport (as an attachment).
Gender changes require a copy of your Birth Certificate, Driver's License, or Passport (as an attachment).
Name changes must be accompanied by a copy of a Social Security Card, Marriage or Divorce Certificate, or Driver's License.
Permanent Home Address - This is the address that remains constant, regardless of your current residence.
Social Security Number changes require a copy of your Social Security Card (as an attachment).

Preferred file formats are PDF or JPG.

Employee UMID

What type of data are you requesting to be changed?

Current Home Address

Date of Birth

Gender

Name Change (First, Middle, or Last)

Permanent Home Address

Social Security Number

Change to Current Home Address Note:

Current Home Address - This is the physical address you are living at. (Your W-2 is mailed to this address).

Enter your updated Current Home Address:

Change to Date of Birth Note:

Date of Birth changes require a copy of your Birth Certicifate, Driver's License, or Passport (as an attachment).

Enter your updated Date of Birth:

Change of Gender Note:

Gender changes require a copy of your Birth Certicifate, Driver's License, or Passport (as an attachment).

Select gender:

Male

Female

Change to Name Note:

Name Changes must be accompanied by a copy of a Social Security Card, Marriage or Divorce Certificate, or Driver's License.

Last Name (enter the changed last name)

First Name (enter the changed first name)

Middle Name (enter the changed middle name)

Change to Permanent Address Note:

Permanent Home Address - This is the address that remains constant, regardless of your current residence.

Enter your updated Permanent Address:

Change to Social Security Number Note:

Social Security Number changes require a copy of your Social Security Card (as an attachment).

Please enter your Social Security Number (this is a secure field):

Attachment

File attachments associated with the ticket.

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Additional Comments:

Questions?

Call the Shared Services Center - HR Customer Care at 734-615-2000 locally, or toll free at 866-647-7657, if you have any questions or need additional assistance. Click on the following link for assistance using the eForm: https://ssc.umich.edu/contact/

Shared Services Center - HR Customer Care is open Monday through Friday. Click on the following link for the available customer service hours: https://ssc.umich.edu/human-resources/

Your name

Your email address

Verification Code

SSC - HR - Retiree Personal Data Change

Questions?

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