Re19 Form – Fill Out and Use This PDF

TIER IV SERVICE RETIREMENT APPLICATION

INSTRUCTIONS

PLEASE READ CAREFULLY

Filing Information

฀ •฀฀฀As฀a฀Tier฀IV฀member฀of฀TRS,฀you฀may฀apply฀for฀service฀retirement฀under฀the฀Qualiied฀Pension฀Plan฀(QPP)฀by฀iling฀a฀ “Tier฀lV฀Service฀Retirement฀Application”฀(code฀RE19).฀TRS฀must฀receive฀your฀retirement฀application฀at฀least฀one฀day,฀ but฀no฀more฀than฀90฀days,฀before฀your฀effective฀retirement฀date.

฀ •฀฀฀Tier฀IV฀members฀may฀only฀elect฀a฀Tier฀IV฀retirement฀beneit.฀If฀you฀are฀a฀Tier฀III฀member,฀you฀may฀elect฀to฀receive฀ either฀Tier฀III฀or฀Tier฀IV฀beneits฀when฀you฀ile฀your฀retirement฀application;฀however,฀you฀may฀not฀combine฀the฀ provisions฀of฀the฀two฀plans.฀Once฀you฀elect฀to฀receive฀a฀beneit฀under฀Tier฀III฀or฀Tier฀IV,฀your฀election฀is฀irrevocable฀ as฀of฀your฀effective฀retirement฀date.

฀ •฀฀฀When฀you฀ile฀this฀application,฀you฀must฀attach฀proof฀of฀your฀date฀of฀birth฀and,฀in฀some฀cases,฀your฀beneiciaries’฀dates฀ of฀birth.฀The฀following฀items฀are฀considered฀acceptable฀proof฀of฀date฀of฀birth,฀and฀only฀one฀of฀the฀following฀is฀required:฀ birth฀certiicate;฀passport;฀or฀naturalization฀document.฀If฀none฀of฀these฀items฀is฀available,฀then฀two฀of฀the฀following฀are฀ required:฀certiicate฀of฀military฀record;฀baptismal฀certiicate;฀life฀insurance฀policy;฀government-issued฀identiication;฀or฀ driver’s฀license.฀(Photocopies฀are฀acceptable฀for฀all฀documents.)฀We฀suggest฀that฀you฀bring฀all฀materials฀in฀person฀to฀ TRS’฀Member฀Services฀Center฀at฀55฀Water฀Street฀in฀lower฀Manhattan.฀Please฀retain฀a฀photocopy฀of฀your฀application฀ and฀all฀forms฀iled฀for฀your฀records.

Retirement Payments

฀ •฀฀฀Generally,฀TRS฀is฀able฀to฀process฀a฀retirement฀beneit฀within฀three฀to฀ive฀months฀of฀your฀effective฀retirement฀date.฀ TRS฀issues฀advance฀payments฀approximately฀one฀to฀two฀months฀after฀your฀effective฀retirement฀date฀to฀provide฀ you฀with฀retirement฀income฀as฀soon฀as฀possible.฀You฀will฀continue฀to฀receive฀an฀advance฀payment฀every฀month฀ until฀your฀regular฀retirement฀allowance฀is฀processed฀and฀initiated฀on฀payroll.฀For฀more฀information,฀please฀see฀the฀ Advance Payments฀brochure.

Change of Information or Cancellation

฀ •฀฀฀You฀may฀change฀any฀information฀on฀your฀application฀after฀you฀have฀submitted฀it;฀TRS฀must฀receive฀your฀changes฀ no฀later฀than฀one฀day฀before฀your฀effective฀retirement฀date.฀However,฀you฀may฀change฀your฀payment฀option฀election฀ up฀to฀30฀days฀after฀your฀effective฀retirement฀date.฀To฀make฀changes฀to฀your฀application,฀you฀may฀visit฀TRS’฀Walk-In฀ Center฀and฀review฀your฀changes฀with฀a฀Member฀Services฀Representative.฀If฀you฀cannot฀visit฀the฀Walk-In฀Center,฀but฀ wish฀to฀make฀changes฀to฀your฀application,฀then฀you฀must฀cancel฀your฀“Tier฀lV฀Service฀Retirement฀Application”฀and฀ submit฀a฀new฀one.

฀ •฀฀฀You฀may฀cancel฀your฀application฀by฀submitting฀a฀“Request฀for฀Withdrawal฀of฀Form/Application/Online฀Filing”฀ (code฀MI5).฀TRS must receive this form at least one day before your effective retirement date, regardless of the date on which you mailed the form or the postmark date on the envelope.฀You฀may฀NOT฀cancel฀your฀ Service฀Retirement฀Application฀on฀or฀after฀your฀effective฀retirement฀date.

For฀your฀convenience,฀TRS฀forms฀and฀publications฀are฀available฀on฀our฀website.฀If฀you฀require฀additional฀assistance,฀we฀ encourage฀you฀to฀contact฀our฀Member฀Services฀Center฀at฀1฀(888)฀8-NYC-TRS.

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HOW TO COMPLETE THE TIER lV SERVICE RETIREMENT APPLICATION

In Part A: PERSONAL INFORMATION

All฀information฀must฀be฀provided.

In Part B: ADDITIONAL MEMBERSHIP INFORMATION

Use฀this฀section฀to฀indicate฀any฀additional฀membership฀information฀(e.g.,฀Multiple฀Employment฀Membership฀or฀Chapter฀683฀ Earnings).฀Multiple฀Employment฀Membership฀status฀is฀assigned฀to฀members฀of฀TRS฀who฀render฀employment฀in฀both฀primary฀ and฀secondary฀TRS-eligible฀positions฀during฀any฀school฀year.฀For฀more฀information,฀please฀see฀the฀Multiple Employment Membership Status฀brochure.

Chapter฀683฀earnings฀apply฀if฀you฀were฀employed฀in฀a฀Special฀Education฀Program,฀in฀accordance฀with฀Chapter฀683฀of฀the฀ Retirement฀and฀Social฀Security฀Law฀(RSSL).฀Please฀note฀that฀conirmation฀of฀your฀Chapter฀683฀earnings฀during฀the฀summer฀ preceding฀your฀retirement฀may฀not฀be฀available฀at฀the฀time฀of฀retirement.฀TRS฀will฀calculate฀your฀retirement฀allowance฀to฀include฀ these฀earnings฀when฀conirmation฀of฀your฀Chapter฀683฀earnings฀becomes฀available.

In Part C: TDA ELECTION

If฀you฀are฀a฀participant฀in฀TRS’฀Tax-Deferred฀Annuity฀(TDA)฀Program,฀you฀must฀make฀a฀decision฀at฀this฀time฀regarding฀the฀distribution฀of฀ your฀TDA฀funds.฀As฀indicated฀below,฀you฀must฀ile฀the฀appropriate฀form(s),฀based฀on฀your฀election,฀in฀conjunction฀with฀iling฀for฀retirement.

ACTION	FORM TO FILE
Receive your TDA funds as an annuity separate	“TDA Annuitization Election Form” (code TD6)
from your QPP retirement allowance.
Withdraw all of your TDA funds.	“TDA Withdrawal Application” (code TD32)
Defer distribution of your TDA funds to a later	“TDA Deferral Status Election Form
date and leave them invested with TRS.	(For Retiring Members)” (code TD30)

For฀more฀information,฀please฀see฀the฀TDA Options at Retirement฀brochure.

In Part D: RETIREMENT ELECTION

You฀must฀provide฀your฀desired฀retirement฀date.฀Your฀retirement฀date฀must฀be฀at฀least฀one฀day฀later฀than฀the฀date฀that฀TRS฀receives฀ this฀application,฀and฀it฀cannot฀be฀earlier฀than฀your฀55th฀birthday.฀In฀addition,฀you฀must฀indicate฀whether฀you฀believe฀you฀are฀eligible฀to฀ receive฀an฀unreduced฀retirement฀allowance฀(full฀beneits)฀or฀a฀reduced฀retirement฀allowance.

In฀general,฀you฀would฀be฀eligible฀to฀receive฀unreduced฀retirement฀allowance฀payments฀(full฀beneits)฀if฀one฀of฀the฀following฀statements฀ applies฀to฀you:

•฀฀You฀are฀at฀least฀age฀62฀as฀of฀your฀retirement฀date฀and฀you฀are฀vested;฀or

•฀฀You฀are฀at฀least฀age฀55฀as฀of฀your฀retirement฀date฀and฀have฀attained฀at฀least฀30฀years฀of฀Total฀Service฀Credit;฀or

•฀฀฀You฀are฀covered฀by฀the฀“55/25”฀provisions฀of฀the฀Age฀55฀Retirement฀Program,฀are฀at฀least฀age฀55฀as฀of฀your฀retirement฀date,฀ and฀have฀attained฀at฀least฀25฀years฀of฀Total฀Service฀Credit;฀or

•฀฀฀You฀are฀covered฀by฀the฀“55/27”฀provisions฀of฀the฀Age฀55฀Retirement฀Program,฀are฀at฀least฀age฀55฀as฀of฀your฀retirement฀date,฀ and฀have฀attained฀at฀least฀27฀years฀of฀Total฀Service฀Credit.

If฀none฀of฀the฀statements฀above฀applies฀to฀you,฀then฀you฀do฀not฀qualify฀for฀unreduced฀payments฀of฀your฀retirement฀allowance.฀ However,฀as฀long฀as฀you฀are฀vested฀and฀at฀least฀55,฀you฀would฀be฀eligible฀to฀retire฀with฀a฀reduced฀retirement฀allowance.฀See฀ Service Retirement Plans and Benefits for Tiers III/IV฀for฀more฀information฀about฀retirement฀allowance฀reductions.

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Vesting

Most฀Tier฀III฀and฀IV฀members฀become฀vested฀upon฀attaining฀ive฀years฀of฀Total฀Service฀Credit.฀However,฀members฀ whose฀TRS฀membership฀began฀after฀December฀10,฀2009,฀and฀who฀are฀working฀in฀a฀title฀represented฀by฀the฀United฀ Federation฀of฀Teachers฀(UFT),฀become฀vested฀upon฀attaining฀10฀years฀of฀Total฀Service฀Credit.

Age 55 Retirement Program*

฀ •฀฀฀Members฀whose฀TRS฀membership฀began฀on฀or฀before฀February฀27,฀2008฀and฀who฀opted฀into฀the฀program฀are฀ covered฀by฀the฀“55/25”฀provisions.

฀ •฀฀฀Members฀whose฀TRS฀membership฀began฀after฀February฀27,฀2008฀and฀on฀or฀before฀December฀10,฀2009฀are฀ covered฀by฀the฀“55/27”฀provisions.฀(Also,฀certain฀members฀whose฀TRS฀membership฀began฀on฀or฀before฀ February฀27,฀2008฀were฀eligible฀to฀opt฀into฀the฀program฀under฀the฀“55/27”฀provisions.)฀

฀ •฀฀฀Members฀whose฀TRS฀membership฀began฀after฀December฀10,฀2009฀and฀before฀April฀1,฀2012฀are฀covered฀by฀the฀ “Chapter฀504”฀provisions,฀which฀include฀the฀vesting฀requirements฀cited฀above.

*Only employees of the Department of Education (DOE) or participating Charter Schools may participate in the Age 55 Retirement Program.

Note for members who participated in the Age 55 Retirement Program: If฀you฀are฀62฀or฀older฀at฀retirement,฀you฀may฀be฀ eligible฀for฀the฀return฀of฀the฀employee portion฀of฀the฀Additional฀Member฀Contributions฀(AMCs)฀you฀made฀under฀this฀program,฀ plus฀accrued฀interest.฀To฀receive฀these฀funds,฀you฀must:฀a)฀retire฀with฀unreduced฀payments;฀b)฀be฀in฀active฀service฀at฀least฀ one฀day฀prior฀to฀your฀effective฀date฀of฀retirement;฀and฀c)฀have฀been฀in฀active฀service฀for฀a฀total฀of฀at฀least฀six฀months฀out฀of฀ each฀of฀the฀two฀twelve-month฀periods฀preceding฀your฀retirement. If฀you฀qualify฀for฀a฀return฀of฀AMC฀funds,฀you฀would฀receive฀a฀separate฀payment฀from฀TRS;฀you฀do฀not฀need฀to฀take฀further฀ action.฀However,฀if฀you฀would฀prefer฀to฀have฀TRS฀directly฀roll฀over฀this฀payment฀to฀an฀eligible฀Individual฀Retirement฀ Arrangement(s)฀or฀other฀successor฀program(s),฀you฀must฀ile฀the฀“Application฀for฀Withdrawal฀of฀Additional฀Member฀ Contributions฀at฀Retirement”฀(code฀RW116)฀and฀the฀“QPP฀Direct฀Rollover฀Election฀Form”฀(code฀RW29)฀at฀this฀time.

In Part E: DESIGNATION OF BENEFICIARY FOR FRACTIONAL PAYMENT OF RETIREMENT ALLOWANCE AND

BENEFICIARY FOR DEATH BENEFIT #2 When฀designating฀beneiciaries฀on฀this฀form,฀please฀provide฀their฀Social฀Security฀numbers฀(or฀alternative฀taxpayer฀ID฀ numbers).฀This฀information฀will฀help฀TRS฀process฀any฀beneits฀that฀later฀become฀payable฀without฀unnecessary฀delay.

Fractional Payment

You฀must฀designate฀a฀beneiciary฀to฀receive฀any฀fractional฀payment฀that฀may฀be฀due฀for฀the฀month฀in฀which฀you฀die.฀This฀ fractional฀payment฀would฀be฀payable฀provided฀that฀you฀do฀not฀die฀on฀the฀last฀day฀of฀the฀month;฀the฀payment฀would฀be฀based฀ on฀the฀number฀of฀days฀that฀you฀are฀alive฀during฀that฀month.

Death Benefit #2

You฀must฀also฀designate฀a฀beneiciary฀to฀receive฀Death฀Beneit฀#2,฀a฀lump-sum,฀post-retirement฀death฀beneit.฀The฀amount฀ of฀this฀death฀beneit฀would฀be฀based฀on฀the฀death฀beneit฀in฀force฀on฀your฀retirement฀date฀(a฀maximum฀equaling฀three฀years’฀ salary,฀subject฀to฀age฀reductions).฀The฀actual฀amount฀payable฀to฀your฀beneiciary฀would฀also฀depend฀on฀the฀amount฀of฀time฀ between฀your฀retirement฀date฀and฀your฀death,฀as฀shown฀in฀the฀table฀below.

	Year of Death
	After Retirement Date				Amount of Death Benefit #2
	1st฀Year฀฀		฀	฀	50%฀of฀benefit฀in฀force฀on฀member’s฀retirement฀date
	2nd฀Year฀฀		฀	฀	25%฀of฀benefit฀in฀force฀on฀member’s฀retirement฀date
	3rd฀Year฀or฀later฀		฀	฀	10%฀of฀any฀benefit฀in฀force฀at฀age฀60฀(or฀10%฀of฀the฀benefit฀in฀force฀on฀
					member’s฀retirement฀date,฀if฀retirement฀occurred฀before฀age฀60.)
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PART G: AFFIRMATION OF UNDERSTANDING

Please฀read฀the฀following฀statement฀and฀sign฀and฀date฀below฀in฀the฀presence฀of฀a฀notary.

I affirm that, to the best of my knowledge, all information I have provided above is true and correct. I understand that the filing of this application is irrevocable and cannot be withdrawn as of my effective retirement date. I also affirm my understanding of the following:

CHANGES AFTER FILING: I understand that any changes I wish to make to this form must be made no later than one day prior to my effective retirement date, with the exception of my payment option election and corresponding beneficiary designations that I elected in Part F, which may be changed within 30 days after my effective retirement date.

VERIFICATION OF SERVICE CREDIT: I understand that TRS will verify all service credit in my account as part of my benefit calculation. I also understand that, if TRS determines that I do not have sufficient service credit to retire under the plan I have elected, TRS may contact me to change my retirement plan or cancel my retirement application.

TERMS OF PAYMENT: If TRS determines that my retirement benefits from TRS are overstated, I am required to repay (or my beneficiaries may be required to repay) the resulting deficit amount in full, in accordance with TRS’ applicable rules.

If my retirement allowance payments are transmitted electronically to my financial institution, I authorize and direct my financial institution to immediately refund any overpayments to TRS, including all payments made by TRS on or after the date of my death, and to charge the same to my bank account. TRS’ certification of overpayment shall be sufficient evidence of an overpayment.

If the funds remaining are not sufficient to permit my financial institution to fully refund overpayments by TRS, I authorize and direct my financial institution to provide to TRS all information related to the designated account, including withdrawals after the first of the month in which my death occurs, the names and addresses of all joint account holders and any individuals authorized to withdraw funds from the designated account, and any changes of address within one year prior to the date of my death.

RETURN OF ADDITIONAL MEMBER CONTRIBUTIONS (AMCs): I understand that, if I participated in the Age 55 Retirement Program and meet certain eligibility requirements, I may receive payment of the employee portion of my AMCs. I authorize TRS to make this separate payment to me (or to roll over the payment to a successor program(s), provided I follow the steps described in the Instructions on page 3).

MEMBER’S฀SIGNATURE฀___________________________________________________฀฀DATE฀(M/D/Y)฀________________

PART H: NOTARIZATION

TO฀BE฀COMPLETED฀BY฀A฀NOTARY฀฀(NOTE:฀Attestation฀made฀outside฀the฀U.S.฀must฀be฀executed฀before฀an฀American฀consul.)

State฀of฀	)
฀	฀)฀s.s.:
County฀of฀	)

On฀the฀_______________฀day฀of฀__________________________,฀__________,฀before฀me฀personally฀appeared฀the฀฀

person฀known฀to฀me฀to฀be฀__________________________________________________________________________,฀the฀

individual฀who฀executed฀the฀foregoing฀instrument฀and฀acknowledged฀to฀me฀that฀(s)he฀executed฀the฀same. Signature:฀___________________________________________________________

Oficial฀Title:฀________________________________________________฀฀Expiration฀Date฀of฀Commission:฀_______________

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