Smart Benefits Application New Withdrawal Change Replacement

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Smart Benefits Application

New___ Withdrawal___ Change____ Replacement ____

Smart Benefits is an “electronic“way to receive your Metrochek transit benefits. Your Metrochek benefits are electronically added each month to your METRO registered SmartTrip card. The SmarTrip card is a permanent plastic farecard that you register with METRO at the time of purchase with your name, address and password.

Rules of Smart Benefits Participation

Any Federal employee who is a Metro Rail, Metro Bus or a registered Smart Benefits vanpool rider and are enrolled in a participating TranServe agency may join this Smart Benefits program.
All Federal employees who participate in the SmartBenefits Program must authorize DOT to verify the accuracy of the name assigned to their SmarTrip Card.
SmartBenefits are available to participating riders on a monthly basis.
Vanpool benefits will be directly deposited into your specific vanpool operator’s account monthly following the participant’s one time on-line designated authorization at WMATA.com after this application is processed.
SmartBenefits for rail and bus riders are available to recipients on a monthly basis to be claimed at any time during the month by downloading the benefit to their SmarTrip card at METRO Passes/Fare cards machines. Existing balances will remain on your card. Benefits may not be claimed for past or future month.
Funds may not be removed from a SmarTrip card once they have been added to the SmarTrip account. If participants change agencies or leave Federal service it is their responsibility to return any unused benefit to their agency.
Federal employees must have a METRO REGISTERED SmartTrip card and provide the serial number of the card. If you have not registered your card or are unsure that it is registered, you may do so by calling METRO at (888)762-7874.
All participants must provide a legible photocopy of the back of their registered SmarTrip card with their completed application.
Applications must include all required information for program participation.
The Smart Benefits team will process applications, register Smartrip cards, and complete initial Vanpool participation registration through WMATA.com for all thoroughly completed applications.
SmarTrip members MUST inform WMATA.com and the Smart Benefits team if they leave or change their registered vanpool before the end of the last month of riding. Riders are responsible for canceling vanpool participation

If you don’t currently have a SmarTrip card, you can purchase one via mail, online, or at Metro’s sales offices and area transit stores. Be sure to register it at time of purchase.

Fax Application to DOT @ 202-366-3464 before the 10^h of the month prior to start month.

What type of Mass Transportation do you use? Please check mode

Metro Rail___ Metro Bus___ Registered Vanpool __

Marc__ VRE___ MTA___MetroAccess_____

Please check the organization within (OS) Department of Commerce…

OAM___ OAS___ OB____OCR___OFM__OGC__OHRM___
OS/ IMM___OPOG___OPERM___OSY___OSBU___

First /Last Name: ______________________________________

Last 4 of SSN: _ Work Phone:

Monthly Transit Cost NOT including parking: $_________
Registered Smartrip card # __________________________________

Work E-mail address: ______________________________
Address___________________________________________________

___________________________________________________________

Signature: __________________________________________________________
Please complete below if joining the Smart Benefits vanpool program:
Van Pool Operator/Company__________________________________________________

Van Pool registration number with WMATA_______________________________________
DOB dd/mm/yyyy____________________________ (required field for on line registration into authorized vanpool on Metro website)

To be filled out by

Agency Transit Coordinator

Authorizing Signature________________________________ Admin/Agency Code______________
Authorized Starting Month___________Authorized Smart Benefit Subsidy Amount____________
PRIVACY ACT STATEMENT: This information is solicited under authority of Public Law 101-509. Furnishing the information on this form is voluntary, but failure to do so may result in disapproval of your request for a public transit fare benefit. The purpose of this information is to facilitate timely processing of your request, to ensure your eligibility, and to prevent misuse of the funds involved. This information will be matched with lists at other Federal agencies of Government-assigned parking to ensure consistency with mode of transportation checked.

Smart Benefits Application New Withdrawal Change Replacement

Rules of Smart Benefits Participation

First /Last Name: ______________________________________

Last 4 of SSN: _______ Work Phone: ______

Last 4 of SSN: _ Work Phone: