Form Rs 6163 A PDF Details

Embarking on retirement brings a plethora of decisions, one of the most pivotal being how to manage your retirement benefits. For members of the New York State and Local Retirement System, particularly those under Tier 2, navigating these financial waters is made clearer with the RS 6163 A form. This document, issued by the Office of the New York State Comptroller, is a gateway for employees of the Employees’ Retirement System and the Police and Fire Retirement System to elect their retirement option. The choices available range from single life allowances, which provide maximum benefits for the retiree's lifetime with no payouts upon death, to various joint and survivor options, ensuring ongoing benefits to a named beneficiary after the retiree's passing. The form also outlines options that return contributions to the estate if the retiree and beneficiary pass away within a certain timeframe after retirement. With the requirement for a notarized signature and timely submission, making an informed decision is crucial. Moreover, the form underscores the importance of naming a beneficiary and the ramifications of each selection, including the possibility of changing beneficiaries under certain conditions, hence shaping the retiree's legacy and financial security of their loved ones. Understanding the RS 6163 A form is therefore an essential step for future retirees aiming to make the most out of their retirement plans.

QuestionAnswer
Form NameForm Rs 6163 A
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesrs6163 a new york state and local police and fire retirement system retirement option election form

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Office of the New York State Comptroller

Retirement Option Election Form

New York State and Local Retirement System

 

Employees’ Retirement System

For Tier 2 Members

Police and Fire Retirement System

 

110 State Street, Albany, New York 12244-0001

RS 6163-A

 

 

(Rev. 12/04)

 

 

MAKE NO ALTERATIONS TO THIS FORM. Please review carefully the options available and the instructions provided. You must 1) elect an option by checking the appropriate box, 2) sign the completed form, 3) have it notarized, and 4) return it promptly.

IMPORTANT: You must file your Option Election form before your pension becomes payable, which is the first day of the month following your retire- ment. You have up to 30 days after your pension benefit becomes payable to change your option selection. If your election is not timely, by law, we must process your retirement as if you had selected the Cash Refund-Contributions (Option 1/2) with your estate named as beneficiary.

INFORMATION ABOUT YOU

1. Name (First, Middle Initial, Last)

3.

Social Security Number*

 

 

 

 

 

 

 

 

 

 

 

2. Address

4.

Registration Number

 

 

 

 

___________________________________________________________

 

 

 

 

 

 

5.

Date of Birth

 

 

 

 

 

 

 

 

 

___________________________________________________________

 

Month

 

Day

 

Year

 

 

 

___________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

*Social Security Number required. (See statement on reverse side.)

 

 

 

 

 

 

To The Comptroller of The State of New York:

 

 

 

Single Life Allowance

ﾆ

I elect to receive the maximum lifetime retirement allowance payable to me. Stop all payments

(Option 0)

 

at my death. I understand that under this option I cannot elect a beneficiary.

000

 

 

 

 

 

 

 

Cash Refund - Contributions

ﾆ

I elect to receive a reduced lifetime retirement allowance. I understand that all payments shall

(Option 1/2)

 

stop at my death, except for the remaining balance of my total member contributions, if any.

 

 

Pay any such balance to my beneficiary. If my beneficiary predeceases me, pay my Estate or

005

 

another beneficiary I may name.

 

 

 

 

 

Joint Allowance - Full

ﾆ

I elect to receive a reduced lifetime retirement allowance, based on my life expectancy and

(Option 2)

 

the life expectancy of my beneficiary. If I die before my beneficiary, continue paying the same

 

 

 

monthly amount to my beneficiary for life. If my beneficiary predeceases me, stop all payments

 

 

at my death. I understand that I cannot change my beneficiary after the last day of the month in

002

 

which I retire.

 

 

 

 

 

Joint Allowance - Half

ﾆ

I elect to receive a reduced lifetime retirement allowance, based on my life expectancy and

(Option 3)

 

the life expectancy of my beneficiary. If I die before my beneficiary, continue paying one-half of

 

 

 

my retirement allowance to my beneficiary for life. If my beneficiary predeceases me, stop all

 

 

payments at my death. I understand that I cannot change my beneficiary after the last day of

003

 

the month in which I retire.

 

 

 

 

 

Five Year Certain

ﾆ

I elect to receive a reduced lifetime retirement allowance. If I die within five years after my

 

 

retirement date, continue paying my retirement allowance for the remainder of the five years to

 

 

 

 

my beneficiary. If my beneficiary predeceases me, but I also die within five years following my

 

 

retirement, continue payments for the rest of the five year period to another beneficiary I may

 

 

name. If there is no surviving beneficiary, make a lump sum payment to my Estate. If I die

006

 

more than five years after my retirement date, stop all payments at my death.

 

 

 

 

 

Ten Year Certain

ﾆ

I elect to receive a reduced lifetime retirement allowance. If I die within ten years after my

 

 

retirement date, continue paying my retirement allowance for the remainder of the ten years to

 

 

my beneficiary. If my beneficiary predeceases me, but I also die within ten years following my

 

 

retirement, continue payments for the rest of the ten year period to another beneficiary I may

 

 

name. If there is no surviving beneficiary, make a lump sum payment to my Estate. If I die

007

 

more than ten years after my retirement date, stop all payments at my death.

 

 

 

Pop-Up Joint Allowance - Full

008

ﾆ

I elect to receive a reduced lifetime retirement allowance, based on my life expectancy and the life expectancy of my beneficiary. If I die before my beneficiary, continue paying the same amount to my beneficiary for life. If my beneficiary predeceases me, change my allowance to the Single Life Allowance (Option 0) amount and stop all payments at my death. I understand that I cannot change my beneficiary after the last day of the month in which I retire.

Pop-Up Joint Allowance - Half

009

ﾆ

I elect to receive a reduced lifetime retirement allowance, based on my life expectancy and the life expectancy of my beneficiary. If I die before my beneficiary, continue paying one-half of my retirement allowance to my beneficiary for life. If my beneficiary predeceases me, change my allowance to the Single Life Allowance (Option 0) amount and stop all payments at my death. I understand that I cannot change my beneficiary after the last day of the month in which I retire.

If you elect the Single Life Allowance (Option 0) do not provide any beneficiary information.

If you wish to elect one of the other options, please read all of the information on this form and then complete the following section. Use the beneficiary’s given name: Mary Smith NOT Mrs. John Smith. If you elect a Cash Refund, or a Year Certain option, and wish to name more than one beneficiary, please let us know and we will provide you with an appropriate form. Please print plainly or type.

INFORMATION ABOUT YOUR OPTION BENEFICIARY

1.

Beneficiary’s Name

3.

Beneficiary’s Social Security Number*

 

 

 

 

 

 

 

 

 

 

2.

Beneficiary’s Address (include Street, City, State and Zip Code)

4.

Relationship of Beneficiary to You

 

 

___________________________________________________________

 

 

 

 

 

 

 

5.

Beneficiary’s Date of Birth

 

 

 

 

 

 

 

 

___________________________________________________________

 

Month

 

 

Day

 

Year

 

 

 

___________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Social Security Number required. (See statement below.)

Retiree’s Signature (sign name in full)

Acknowledgement To Be Completed by a Notary Public

State of____________________________________________________ County of ______________________________________________________

On the _______________ day of ________________________ in the year _______________________, before me, the undersigned, personally

appeared______________________________________________________________ personally known to me or proved to me on the basis of

satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they

executed the same in his/her/their capacity(ies) and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of

which the individual(s) acted, executed the instrument.

______________________________________________________

NOTARY PUBLIC (Please sign and affix stamp)

Electing an Option

The option you elect is important to both you and your beneficiary. Be sure you understand the nature of each option, and elect the one that best fulfills your needs. Be sure that you have checked the proper box for the option that you wish to elect. On this form, you are selecting a method of payment. When you have completed this form and have had it notarized, the original should be returned to: New York State and Local Retirement System, 110 State Street, Albany, New York 12244. When your option form is received in this office, we will acknowledge receipt of the option selection by sending you a letter.

Designating a Beneficiary

Only one beneficiary may be named in a Joint Allowance or Pop-Up option. Under these options, proof of your beneficiary’s date of birth must be submitted.

If you wish to elect a Cash Refund Option or one of the Years Certain Options, you may designate more than one beneficiary. If you wish to do so, please notify the Retirement System so that we may send you the proper form for completion. If you elect one of the Cash Refund or Years Certain Options, you may designate your Estate as beneficiary. Under these options, you may change your beneficiary at any time. For each change of beneficiary(ies), you must submit a form which can be obtained from the Retirement System.

Information Services

Information Representatives are available at 16 consultation sites throughout New York State. To find the one nearest you, visit our website at www.osc.state.ny.us/ retire. You can also contact our Call Center toll-free at (866) 805-0990, or (518) 474-7736 in the Albany area.

Social Security Disclosure Requirement

In accordance with the Federal Privacy Act of 1974, you are hereby advised that disclosure of your Social Security account number is mandatory pursuant to Sections 11, 34, 311 and 334 of the Retirement and Social Security Law. The number will be used in identifying retirement records and in the administration of the Retirement System.

Personal Privacy Protection Law

The Retirement System is required by law to maintain records to determine eligibility for and calculate benefits. Failure to provide information may interfere with the timely payment of benefits. The System may be required to provide certain information to participating employers. The official responsible for record maintenance is the Director of Member and Employer Services, NYS and Local Retirement System, Albany, NY 12244; call toll-free at 1-866-805-0990 or 518-474-7736 in the Albany area.

RS 6163-A (Rev. 12/04)

How to Edit Form Rs 6163 A Online for Free

Whenever you need to fill out Form Rs 6163 A, there's no need to download any software - simply use our online tool. Our editor is continually developing to give the very best user experience attainable, and that is due to our resolve for constant improvement and listening closely to user opinions. Starting is easy! All you have to do is adhere to these simple steps directly below:

Step 1: Access the PDF form inside our tool by pressing the "Get Form Button" at the top of this page.

Step 2: As you open the editor, you will find the form made ready to be filled out. Apart from filling out different fields, it's also possible to do many other actions with the file, including writing any textual content, modifying the initial textual content, adding graphics, putting your signature on the form, and more.

With regards to the blanks of this particular form, this is what you should consider:

1. To start with, when filling out the Form Rs 6163 A, start in the form section that features the next fields:

A way to prepare Form Rs 6163 A part 1

2. Your next step would be to fill in these particular blank fields: Joint Allowance Half Option, Five Year Certain, Ten Year Certain, I elect to receive a reduced, the life expectancy of my, I elect to receive a reduced, retirement date continue paying my, I elect to receive a reduced, and retirement date continue paying my.

Stage number 2 in completing Form Rs 6163 A

3. This next step is normally easy - complete every one of the fields in PopUp Joint Allowance Full, PopUp Joint Allowance Half, I elect to receive a reduced, life expectancy of my beneficiary, I elect to receive a reduced, If you elect the Single Life, INFORMATION ABOUT YOUR OPTION, Beneficiarys Name, Beneficiarys Social Security, Beneficiarys Address include, and Relationship of Beneficiary to You to conclude this process.

Form Rs 6163 A writing process outlined (portion 3)

4. This next section requires some additional information. Ensure you complete all the necessary fields - Beneficiarys Date of Birth, Month, Day, Year, Social Security Number required, Retirees Signature sign name in, Acknowledgement To Be Completed by, State of County of, On the day of in the year, appeared personally known to me or, satisfactory evidence to be the, executed the same in hishertheir, which the individuals acted, NOTARY PUBLIC Please sign and, and Electing an Option The option you - to proceed further in your process!

The best ways to fill out Form Rs 6163 A step 4

Concerning Month and Day, be certain that you don't make any mistakes in this current part. Both of these could be the most important fields in the PDF.

5. Lastly, this final portion is precisely what you will need to complete prior to closing the form. The blank fields in this case are the next: Information Services Information, Social Security Disclosure, Personal Privacy Protection Law, and RS A Rev.

Writing section 5 in Form Rs 6163 A

Step 3: Revise all the information you've entered into the form fields and click on the "Done" button. Right after creating afree trial account with us, you will be able to download Form Rs 6163 A or email it at once. The PDF will also be accessible through your personal account with your modifications. We don't sell or share the details you enter whenever completing documents at our website.

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