Guide 135A (2014-09) 1 of 1Commission administrative des régimes de retraite et d’assurances

GENERAL INFORMATIONYou do not need to file this form to have a correction made to your date of birth, your name or your address. To obtain information on how to proceed to correct those particulars, simply contact CARRA by telephone or in writing. For a correction to your participation data, your employer must complete the form Demande de modification des données de participation à un regime de retraite (291), (available in French only) and send it to CARRA.

FILING A CORRECTION REQUESTIf you wish to file an official request under the Act Respecting Access to Documents Held by Public Bodies and the Protection of Personal Information (Access Act), CARRA makes the form available, the use of which is optional. You can also use it to have removed personal information that CARRA should not have under the access act. The information you will provide in the “Identification of the person who applies” and “Nature of the Personal Information to be Corrected” sections is confidential and will be disclosed only to authorized agents.

If you wish to obtain more information regarding the Access Act, you can go to ”Access to Information” on our website, or contact CARRA’s person in charge of access to documents and protection of personal information at the following phone number 418 644-1025.

Your application for correction must be filed in writing to the person in charge of access.

ORGANIZATIONS SUBJECT TO THE ACCESS ACTAn index provides the list of all public bodies subject to the Access Act, with the names of the persons in charge to whom requests must be addressed. The index is available from ministries and government agencies, municipalities, school boards and health and social services institutions. It is also available at Service-Québec, public libraries, as well as regional ministries and government agencies, and on the Commission d’accès à l’information’s website.

PROCESSING OF THE CORRECTION REQUESTSUpon receipt of the form or any other written request, the person in charge of access will send you an acknowledgement of receipt informing you of the date when you will receive a written reply to your request. The time limit provided in the Access Act to reply to a request is 20 calendar days.

If your request for correction is accepted by CARRA, we will send you, free of charge, a copy of any amended or added information, or a confirmation that the information has been deleted.

Upon your request, CARRA will also send to the organization from which it received the information, or to any organization to which the information may have been disclosed as part of an agreement under the Access Act, a copy of the amended or added personal information, or a copy of the confirmation that the information has been deleted from its files.

If you are a member of one of the plans administered by CARRA or a beneficiary, we ask you to provide your social insurance number so that we can identify you in our files.

Finally, if CARRA denies your request for correction, it must inform you in writing. Then, you can then ask that your request be recorded in your file.

Please return this form at the following address:

Personne responsable de l’accès aux documents et de la protection des renseignements personnels Commission administrative des régimes de retraite et d’assurances 475, rue Saint-Amable Québec (Québec) G1R 5X3

Guide to the Application for Correction of Personal Information under the “Access Act”

135A(2014-09)

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135A (2014-09) 1 of 2Commission administrative des régimes de retraite et d’assurances

Last name First name Social insurance number

Number Street, avenue, boulevard, rural route Apartment P.O. Box

City, town, municipality Province Postal code

Area code Telephone (Home) Area code Telephone (Work) Extension

1. Nature of the personal information to be corrected

2. Correction requested

3. Reason for the correction, if applicable

Signature Date

Year Month Day

Part A – Identification of the person who applies

Application for Correction of Personal Information under the “Access Act”

Home address

Part B – Subject of the application for correction

Note: You do not need to file this form to have a correction made to your date of birth, your name or your address. To obtain information on how to proceed to correct those particulars, simply contact CARRA’s Direction des contacts clients at 418 643-4881 (Québec region) or 1 800 463-5533 (toll free). Also, if you find an error on your Statement of Contributions, you must inform your employer who will contact CARRA to have it corrected.

135A(2014-09)

Part C – Signature of the person who applies

I hereby confirm that the information provided in the “Identification of the person who applies” section is accurate.

135A (2014-09) 2 of 2Commission administrative des régimes de retraite et d’assurances

Date de réception de la demande Date limite de réponse

Date d’envoi de l’accusé de réception Date de communication de la décision

Date d’envoi du document par courrier recommandé

Analyse et décision :

Année Mois Jour Année Mois Jour

Année Mois Jour Année Mois Jour

Année Mois Jour

Please return this signed form to:By mailCommission administrative des régimes de retraite et d’assurances 475, rue Saint-Amable Québec (Québec) G1R 5X3

By fax418 644-8659

By secure emailwww.carra.gouv.qc.ca/infocarra

TO CONTACT US

By phone 418 643-4881 (Québec region) 1 800 463-5533 (toll free)

Persons with a hearing impairment 418 644-8947 (Québec region) 1 855 317-4076 (toll free)

Subscribe to our electronic mailing list.Subscribe to CARRA’s electronic mailing list to receive news regarding the various pension plans. The registration form is available on our website at the following address: www.carra.gouv.qc.ca/liste.

Part D – À l’usage de la CARRA