Form R0717G PDF Details

Are you perplexed by the Form R0717G? You're not alone! This tax form can be confusing, but it's important to understand it if you want to avoid penalties. In this blog post, we'll break down the Form R0717G and explain what each section means. We'll also provide tips on how to complete the form correctly.

You can find information regarding the type of form you intend to fill out in the table. It can tell you the time it will need to finish form r0717g, what fields you need to fill in and several additional specific details.

Form NameForm R0717G
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesCumulative, HRMN, USERRA, vesting

Form Preview Example

Department of Technology, Management, & Budget

Office of Retirement Services (800) 381-5111

P.O. Box 30171

Lansing MI 48909-7671

Application for Military Leave of Absence Credit

For State Defined Contribution Participants






( )


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 percent 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 percent 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 (DD214) confirming my entry and separation dates. For copies of your military papers, write to: National Personnel Records Center, Military Personnel Records, 9700 Page Ave., St. Louis, MO 63132-5100. You can also request your discharge papers online by visiting

By my signature below, I attest that 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).



Please complete and return with required proofs to:

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

R0717G (Rev. 5/2013)

Authority: 1943 P.A. 240, as amended

Eligibility Conditions and Instructions


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 ten-year vesting requirement).

If you meet all of 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 four percent of the state pay you would have received if you had not been called to duty.


If eligible, you will receive service credit when you return to work and submit this form with your military discharge papers (DD214).

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.

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 percent or 5 percent 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, 2007, after one year of military duty, you must make up any elective contributions within three years, which would be May 1, 2010.

R0717G (Rev. 5/2013)

Authority: 1943 P.A. 240, as amended

Watch Form R0717G Video Instruction

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