Npers2430 Form PDF Details

Are you new to filing out the Npers2430 form? Are you looking for information on how the forms work and what it entails? If so, then this blog post is specifically written for you. We will be discussing all of the information that is required when completing this form, as well as giving an overview of its content and purpose. With today's global economy, understanding government regulations such as these can help businesses make decisions that are in compliance with their own laws. So if your business requires submission of this specific paperwork, then read on to learn more!

QuestionAnswer
Form NameNpers2430 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesStCoNonCon npers form

Form Preview Example

 

1221 N Street, Suite 325, P.O. Box 94816

NPERS

Lincoln, NE 68509-4816

Fax 402-471-9493

 

402-471-2053 or 800-245-5712

Nebraska Public Employees

www.npers.ne.gov

R e t i r e m e n t S y s t e m s

Last

 

First

 

 

Middle

 

 

 

Plan Type

Name

 

 

 

 

 

Date of Birth

-

-

(Check One)

Social Security Number

-

-

 

Retirement Number

 

 

State

Address

 

 

City

 

 

State

Zip

 

County

Home Phone

Work Phone

 

 

Employer

 

 

 

 

 

 

 

 

 

 

 

 

 

State/County Non-Contributing Member Form

This form serves as official notification that a member has ceased employment. According to §23-2301 (County) and § 84-1301 (State), termination of employment occurs on the date on which the state/county determines that the member’s employer-employee relationship has dissolved. The employer shall notify NPERS of the date on which termination has occurred. This form is also used if there is any other interruption of a member’s retirement contributions, such as seasonal employment or a leave of absence.

Ceased Employment

Termination Date _____________________________________________________________

Date of Final Pay __________________________ Gross Final Pay $ ___________________

Emergency Warrant Issued?

Yes

No

 

 

 

Reason for Termination

 

 

 

 

 

Resigned

Deceased

 

Disability

Retired

 

 

Transfer from ___________________________ to ____________________________

 

Dismissed - If dismissed, is a grievance or appeal of the termination pending?

Yes

No

Leave or Intermittent Status

Last Pay Date ________________________________________________________________

Reason for Change in Status

 

 

 

Military Leave

Disability

Family Medical

Seasonal/Intermittent

Suspension

Other (explain) ____________________________________________________________

Anticipated Date of Return (if known) _____________________________________________

This certifies that the above information is correct to the best of my knowledge.

 

Agency/County Signature _____________________________________________

Date _______________________

Typed or printed name of Agency Contact _______________________________

Title _______________________

Telephone Number ______________________________________

 

NPERS2430 Rev. 09/05

BAR CODE

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With regards to the blanks of this specific document, here's what you need to know:

1. It is recommended to complete the Npers2430 Form properly, therefore be careful when working with the sections comprising these blank fields:

Find out how to prepare Npers2430 Form portion 1

2. Right after this array of blank fields is filled out, go on to type in the suitable information in all these - Leave or Intermittent Status, Last Pay Date, Reason for Change in Status cid, cid Other explain, Anticipated Date of Return if, This certifies that the above, Date, Title, Telephone Number NPERS Rev, and BAR CODE.

Npers2430 Form completion process detailed (step 2)

People often get some points wrong while filling out Telephone Number NPERS Rev in this section. Don't forget to reread what you type in here.

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