Trsl Form 15 PDF Details

For retirees of the Teachers' Retirement System of Louisiana (TRSL) considering a return to work in a TRSL-eligible position, navigating the complexities of how such a decision impacts their retirement benefits is crucial. Introduced to streamline this process, the TRSL 15 form, also known as the Retiree Return-to-Work Notification, is a key document providing a structured path for retirees. This form, which must be filled out with care using ink or typed entries, contains several sections that cover a wide range of important information. It begins with personal details of the retiree, including name, social security number, and retirement date, followed by a selection of the return-to-work option that best fits the retiree's situation. Options include returning to work with full benefits after a 12-month waiting period or regaining active membership with the complete understanding of its financial implications, such as the cancellation of retirement benefits and the requirement to return all received benefits with interest. Additionally, it outlines the process of beneficiary designation, allowing retirees to specify who will receive contributions remitted to TRSL in the event of their death before withdrawal. This comprehensive approach ensures that retirees are fully informed about the consequences of returning to work on their retirement benefits and the necessary actions to take, making the TRSL 15 form an essential tool for navigation through this significant life decision.

QuestionAnswer
Form NameTrsl Form 15
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names15 return to work template louisiana form

Form Preview Example

Teachers’ Retirement System of Louisiana

 

Form 15 (02/05)

8401 Unit ed Plaza Boulevard • Bat on Rouge, LA 70809-7017

 

 

 

07-15

P.O. Box 94123 • Bat on Rouge, LA 70804-9123

 

 

Telephone: (225) 925-6446 • Fax: (225) 925-4779

Use only for retirees

w w w .t rsl.org

w ho return to w ork

 

in a TRSL-eligible

Retiree Return-to-Work Notification

position

 

 

 

Print in ink or type all entries except signatures. This f orm must be complet ed by ret irees of t he Teachers’ Ret irement Syst em of Louisiana (TRSL) w ho

ret urn t o w ork in a TRSL-eligible posit ion. Any ref erence t o f iscal year means July 1 t hrough June 30. Disability retirees returning to w ork w ill have their benefits terminated.

Section 1—Retiree information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nam e: Last , f irst , M I, suf f ix (Jr., III, et c.)

 

 

 

 

Social Securit y number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

St reet / P.O. Box

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cit y, st at e, zip

Dayt im e t elephone

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dat e of ret irem ent (m m -dd -yyyy)

Check one (* ILSB = Initial Lump-Sum Benefit, formerly Option 5)

 

 

 

 

Regular retiree

 

DROP or ILSB* retiree

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 2—Return-to-w ork option selection (Choose one only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am ret urning t o w ork under t he opt ion designat ed below :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

______

FULL BENEFITS AFTER 12-M ONTH WAITING PERIOD SINCE RETIREM ENT (LSA-R.S. 11:710, effective July 1, 2001)

 

 

 

 

 

 

 

(Init ial)

I underst and t hat if I ret urn t o w ork bef ore t he end of t he 12-mont h w ait ing period af t er my ret irement , my benef it f rom TRSL w ill be suspended f or

 

t he durat ion of t he employment or t he lapse of t he 12-mont h w ait ing period, w hichever occurs f irst . If I have complied w it h t he required 12-mont h

 

w ait ing period bef ore ret urning t o w ork under t his provision, I w ill receive f ull ret irement benef it s f rom TRSL. I underst and t hat unshelt ered cont ribu-

 

t ions w ill be deduct ed f rom my pay and remit t ed t o TRSL in eit her case. I underst and t hat I may not elect t his opt ion if I have previously ret urned t o

 

w ork under anot her provision during t his current f iscal year.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

______

REGAINING ACTIVE M EM BERSHIP IN TRSL (LSA-R.S. 11:738) – Not available to DROP or ILSB* retirees

 

 

 

 

 

 

 

(Init ial)

I request a cost of regaining membership in TRSL. I underst and t hat my ret irement benef it w ill be canceled and t hat I w ill have t o ret urn all ret irement

 

benef it s received f rom TRSL plus int erest at t he board-approved act uarial rat e and pay employee and employer cont ribut ions on the earnings I have

 

received since reemployment , plus compound int erest at t he board-approved act uarial rat e.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If t his opt ion is chosen, an Enrollment Applicat ion/Employment Not if icat ion (Form 2) must be sent t o TRSL. If applicable, a PIP Not ice of Ret iree Ret urning t o Service f orm must be complet ed by employer.

Section 3—Agency verification

This ret iree began or w ill begin w orking f or ________________________________________ , agency #

, on _____/______/___________.

(m m -dd -yyyy)

I cert if y t hat t he ret iree has ret urned t o w ork under t he provision select ed above and meet s all requirement s necessary t o ret urn t o w ork under such provision. If required, unshelt ered employee and employer ret irement cont ribut ions w ill be remit t ed t o TRSL. Said employer w ill not if y TRSL in w rit ing of t he t erminat ion dat e of t his ret iree.

Em ployer’s signat ure (Aut horized agency represent at ive— no f acsim ile accept ed)

✁

Section 4 — Beneficiary designation

Dat e signed (m m -dd -yyyy)

I hereby designate the follow ing beneficiary to receive the amount of contributions remitted to TRSL during my reemployment in the event of my death before w ithdraw ing these contributions from TRSL. To add more beneficiaries, complete Section 4 on another Form 15 and attach.

Nam e: Last , f irst , M I, suf f ix (Jr., III, et c.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Social Securit y number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

St reet / P.O. Box

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cit y, st at e, zip

 

 

Dayt im e t elephone

 

 

(

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ret iree’s signat ure (Do not print or t ype)

 

 

Dat e signed (m m -dd -yyyy)

✁

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M ust be w itnessed by persons other than beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signat ure of w it ness (Do not print or t ype)

Signat ure of w it ness (Do not print or t ype)

 

 

 

 

 

 

 

 

 

 

✁

✁

 

 

 

 

 

 

 

 

 

 

St reet / P.O. Box

St reet / P.O. Box

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cit y, st at e, zip

Cit y, st at e, zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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This PDF form requires specific data to be typed in, hence you should definitely take your time to provide what's expected:

1. To begin with, while filling in the Trsl Form 15, beging with the area that contains the subsequent blank fields:

Part # 1 in submitting Trsl Form 15

2. Once your current task is complete, take the next step – fill out all of these fields - Section Agency verification, This retiree began or w ill begin, m m ddyyyy, I certify that the retiree has, Em ployers signat ure Aut horized, Dat e signed m m ddyyyy, Section Beneficiary designation, I hereby designate the follow ing, Name Last f irst M I suf f ix Jr, St reet PO Box, Cit y st at e zip, Ret irees signat ure Do not print, M ust be w itnessed by persons, Social Security number, and Dayt im e t elephone with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

How you can complete Trsl Form 15 stage 2

It's easy to make a mistake when filling in the Dat e signed m m ddyyyy, hence you'll want to go through it again before you finalize the form.

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