Form R0717G PDF Details

Navigating the process of ensuring your financial benefits and employment rights are preserved during military service can feel overwhelming, but for state of Michigan employees, the R0717G Application for Military Leave of Absence Credit form serves as an essential stepping stone in this journey. It is designed specifically for participants in the state's Defined Contribution Retirement Plan, offering them an opportunity to claim service credit and ensure continued employer contributions to their 401(k) plan throughout their period of active duty military service. The form outlines eligibility criteria which hinge on the guidelines set by the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA), detailing the types of service that qualify and setting forth a path for applying for these benefits. Moreover, it addresses the possibility of making elective contributions to one's account, thereby maintaining the full employer match, emphasizing the importance of timely submission of this application along with the necessary military discharge papers (DD Form 214) upon return to civilian work. Not only does this form facilitate the acknowledgement and compensation for the time state employees spend in military service, but it also outlines the specifics around eligibility conditions, elective contributions, and the procedural steps for ensuring these rights are fully realized.

QuestionAnswer
Form NameForm R0717G
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesretiree, 2010, USERRA, Reemployment

Form Preview Example

 

 

Toll Free:

800-381-5111

 

 

Local: 517-284-4400

P.O. Box 30171 · Lansing, MI 48909-7671

www.michigan.gov/ors

Fax:

517-284-4416

Application for Military Leave of Absence Credit

For State Defined Contribution Participants

NAME

HRMN IDENTIFICATION NUMBER

MAILING ADDRESS

DAYTIME TELEPHONE

CITY, STATE, ZIP CODE

NAMES SERVICE PERFORMED UNDER (IF DIFFERENT FROM ABOVE)

EMAIL ADDRESS

Use this form to request service credit and employer contributions to your Defined Contribution Retirement Plan during active duty military service performed while a state of Michigan employee. ORS will review your application and proofs; and, if you are eligible, you will be granted military service credit for the time you spent in uniformed service. Your 401(k) will be credited state contributions equal to 4% of the state pay you would have received if you had not been called to duty. If you check the box below to make elective employee contributions (and thereby receive the full state match), you will be contacted for payment arrangements.

Please review the reverse side for eligibility conditions and instructions.

I am applying for:

Service credit to reflect a military leave of absence.

4% employer contribution to my 401(k) Defined Contribution Retirement Plan.

I also wish to:

Make elective contributions to my 401(k) Defined Contribution Retirement Plan account (and thereby qualify for the full employer match).

Make elective contributions to my 401(k) Defined Contribution Personal Healthcare Fund Plan account (and thereby qualify for the full employer match).

I was a state of Michigan employee on active duty military service during these dates:

Type of Service

Date of Entry

Date of Separation

Intervening Active Duty

I am including a photocopy of my military discharge papers (DD Form 214) confirming my entry and separation dates.

By my signature below, I attest I will not be receiving credit for this service under another retirement system (with the exception of retirement benefits from the federal government for service in the Reserve component).

APPLICANT SIGNATURE

DATE

Please complete and return with required proofs to:

Michigan Office of Retirement Services, P.O. Box 30171, Lansing MI 48909-7671

Department of Technology, Management & Budget

R0717G (Rev. 2/2022) Authority: 1943 P.A. 240, as amended

Eligibility Conditions and Instructions

Eligibility

A participant in the state of Michigan’s 401(k) Defined Contribution Retirement Plan is eligible to receive service credit for time spent on a military leave of absence in accordance with the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA).

Service credit for time you spent on military leave can be used to meet the vesting requirement for both employer contributions (a four-year vesting requirement) and retiree health insurance (a 10-year vesting requirement).

If you meet the criteria for a military leave of absence as described by the Department of Civil Service, the state will increase your service credit hours and contribute an amount equal to 4% of the state pay you would have received if you had not been called to duty.

Conditions

If eligible, you will receive service credit when you return to work and submit this form with your military discharge papers (DD Form 214).

After discharge, you must return to employment within the allowed decompression time as set forth by the Department of Civil Service.

You must have left state employment to serve in one of the uniformed services: Army, Navy, Marine Corps, Air Force, Coast Guard, Reserves, National Guard, and the Commissioned Corps of the Public Health Service.

Cumulative absences from your job for military service cannot exceed five years unless the additional service falls under one of the exceptions in Civil Service Regulation 2.04, Military Leaves of Absence and Return to Work: Basic Rights.

You cannot receive credit for military service if you receive credit for the same service under another retirement system. However, this restriction doesn’t apply if you will be eligible to retire from the federal government for service in the Reserve component.

If your military leave of absence meets the criteria established under the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA*), you will be

granted service credit for the time you served in the military (subject to statutory limits) and any creditable decompression time allowed under the following guidelines: Less than 31 days. Your military service and travel time from the place of service to your residence, plus 8 hours. 31 to 180 days. Your military service and up to 14 days of decompression time. 181 or more. Your military service and up to 90 days of decompression time. *USERRA is a federal law that provides reemployment rights for individuals who have served in the military.

Elective Contributions

You can make up the elective contributions you missed while on military leave. If you choose to make up your elective contributions to your 401(k) account, the state will match those contributions up to 3% or 5% if you are in the Personal Health Care Fund.

If you check the elective contributions box on the front of this form, the Office of Retirement Services will contact you to explain your payment options.

Payment of elective contributions must take place within a period equal to three times the length of your immediate past military service, but not longer than five years. For example, if you returned to work on May 1, 2021, after one year of military duty, you must make up any elective contributions within three years, which would be May 1, 2024.

For copies of your military papers, write to: National Personnel Records Center, Military Personnel Records, 9700 Page Avenue, St. Louis, MO 63132- 5100. You can also request your discharge papers online by visiting www.archives.gov.

R0717G (Rev. 2/2022) Page 2

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Step 1: To get going, press the orange button "Get Form Now".

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filling out vesting part 1

Type in the information in the Type of Service, Date of Entry, Date of Separation, Intervening Active Duty, I am including a photocopy of my, By my signature below I attest I, APPLICANT SIGNATURE, DATE, and Please complete and return with field.

stage 2 to finishing vesting

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