Date: December 21, 2005 Bulletin Number: 609

New Next of Kin Affidavit Form for OSC's Bureau of State Payroll Services


To notify agencies of IRS reporting requirements for deceased employee payments and the new Next of Kin Affidavit form (AC 934-P) for payroll transactions.

Affected Individuals

Beneficiaries of deceased State employees.


IRS requires salary payments made to a deceased employee’s beneficiary be reported on Form 1099-MISC Miscellaneous Income. The Form 1099-MISC must include the Social Security number(s) and the address(es) of the recipient(s) of the salary payment.

OSC Actions

This Next of Kin Affidavit form (AC 934-P) was created for payroll transactions only and provides space for the reporting of the recipient's Social Security number.

Effective Date(s)


Agency Actions

Agencies must provide all Social Security numbers and the addresses of all recipients when submitting the AC 934-P to OSC.

Please include the Report of Check Exchange form (AC 1476-P) when submitting a Next of Kin Affidavit form (AC 934-P).

Click here to access the Next of Kin Affidavit form available on the OSC Web site.

Agencies may contact OSC's Office Services by telephone at 518-474-3438 or by fax at 518-473-4560 to request a supply of the form.


AC 934-P - Next of Kin Affidavit


Questions regarding this bulletin may be directed to the Payroll Deductions mailbox.