INSTRUCTIONS: ARIZONA OUT OF STATE/FEDERAL SERVICE AFFIDAVIT (Form EOSS)

Arizona elected officials with at least five years of credited service within the state Elected Officials' Retirement Plan may redeem up to five years of prior elected service out of state or in a federal capacity. This is done by filing a form EOSS. This document can be obtained from the website maintained by the Elected Officials' Retirement Plan of the State of Arizona. 

Arizona Out Of State/Federal Service Affidavit EOSS Step 1: Enter your name on the first line, your Social Security number on the second line, and your date of birth on the third line.

Arizona Out Of State/Federal Service Affidavit EOSS Step 2: Enter your complete street address on the fourth line and your telephone number on the fifth line.

Arizona Out Of State/Federal Service Affidavit EOSS Step 3: Enter the name of your former employer or retirement system on the sixth line.

Arizona Out Of State/Federal Service Affidavit EOSS Step 4: Enter your position formerly held on the seventh line.

Arizona Out Of State/Federal Service Affidavit EOSS Step 5: Enter the name of a contact person on the eighth line.

Arizona Out Of State/Federal Service Affidavit EOSS Step 6: Enter the address of your former employer or retirement system on the ninth line and its telephone number on the tenth line.

Arizona Out Of State/Federal Service Affidavit EOSS Step 7: Enter your prior service beginning and ending dates on the eleventh and twelfth lines.

Arizona Out Of State/Federal Service Affidavit EOSS Step 8: On the next line, indicate with a check mark whether you received compensation for your employment during this service period.

Arizona Out Of State/Federal Service Affidavit EOSS Step 9: Enter the number of months you wish to have calculated.

Arizona Out Of State/Federal Service Affidavit EOSS Step 10: On the next four lines, give all information requested about your current employment.

Arizona Out Of State/Federal Service Affidavit EOSS Step 11: Initial all applicable statements on the next five lines.

Arizona Out Of State/Federal Service Affidavit EOSS Step 12: Sign and date the bottom of the page.

Arizona Out Of State/Federal Service Affidavit EOSS Step 13: The form must be presented to a notary public for their seal.

INSTRUCTIONS: ALABAMA APPLICATION FOR SURVIVOR BENEFIT

Survivors of deceased members of the Alabama Employees' Retirement System or Teachers' Retirement System can file the form discussed in this article to receive their benefits. The document can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Application For Survivor Benefit Step 1: Indicate whether the deceased was a members of the Employees' Retirement System or Teachers' Retirement System by filling in the oval next to the applicable statement.

Alabama Application For Survivor Benefit Step 2: On the first blank line, enter the full name of the deceased.

Alabama Application For Survivor Benefit Step 3: On the second blank line, enter the Social Security number of the deceased.

Alabama Application For Survivor Benefit Step 4: On the third blank line, enter the date of birth of the deceased.

Alabama Application For Survivor Benefit Step 5: On the fourth blank line, enter the date of death of the deceased.

Alabama Application For Survivor Benefit Step 6: On the fifth blank line, enter the employing agency of the deceased.

Alabama Application For Survivor Benefit Step 7: On the sixth blank line, enter the full name of the surviving beneficiary.

Alabama Application For Survivor Benefit Step 8: On the seventh blank line, enter the date of birth of the beneficiary.

Alabama Application For Survivor Benefit Step 9: On the eighth blank line, enter the relationship to the deceased of the beneficiary.

Alabama Application For Survivor Benefit Step 10: On the ninth blank line, enter the Social Security number of the beneficiary.

Alabama Application For Survivor Benefit Step 11: On the tenth blank line, enter the telephone number of the beneficiary.

Alabama Application For Survivor Benefit Step 12: On the eleventh blank line, enter the complete address of the beneficiary.

Alabama Application For Survivor Benefit Step 13: In Part II, the beneficiary should sign and date the form. 

Alabama Application For Survivor Benefit Step 14: The beneficiary should have the remainder of Part II completed by a notary public.

Alabama Application For Survivor Benefit Step 15: Part III should be completed by the payroll official of the employer of the deceased.

Alabama Application For Survivor Benefit Step 16: File this return by mailing it to the address at the top of the page. A certified original death certificate must be attached.

INSTRUCTIONS: ALABAMA SERVICE CALCULATION (Form ERS F SC)

Those enrolled in the Employees' Retirement System of Alabama can use a form ERS F SC to request the establishment of a retirement credit for several different types of employment. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Service Calculation ERS F SC Step 1: On the first blank line, enter your full name.

Alabama Service Calculation ERS F SC Step 2: On the second blank line, enter your Social Security number.

Alabama Service Calculation ERS F SC Step 3: On the third blank line, enter your registration number.

Alabama Service Calculation ERS F SC Step 4: On the fourth blank line, enter your street address or P.O. box number, city, state and zip code.

Alabama Service Calculation ERS F SC Step 5: Do not complete the two tables, which are for agency use anyway. Below these, check the box next to the first statement if you are seeking a retirement credit for full time hourly rate employment.

Alabama Service Calculation ERS F SC Step 6: Check the box next to the second statement if you are seeking a retirement credit for part-time employment on a percentage basis. Enter the percent.

Alabama Service Calculation ERS F SC Step 7: Check the box next to the third statement if you are seeking a retirement credit for provisional (non-temporary) employment.

Alabama Service Calculation ERS F SC Step 8: Check the box next to the fourth statement if you are seeking a retirement credit for full-time employment during a period of non-enrollment due to administrative error. By checking this statement, you acknowledge that the agency is also required to make a payment for their error.

Alabama Service Calculation ERS F SC Step 9: Check the box next to the fifth statement if you are seeking a retirement credit for your work as an elected official. Enter the name of the office you served in.

Alabama Service Calculation ERS F SC Step 10: Check the box next to the sixth statement if you are seeking a retirement credit for another reason. Provide a written explanation.

Alabama Service Calculation ERS F SC Step 11: Submit this form to the appropriate agency official, who will complete the tables, then sign and date the bottom of the page.

INSTRUCTIONS: ALABAMA SERVICE CALCULATION (Form ERS F SC)

To establish retirement credit with the Employees' Retirement System of Alabama, file the form discussed in this article. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Service Calculation ERS S FC Step 1: Enter your name on the first blank line.

Alabama Service Calculation ERS S FC Step 2: Enter your Social Security number on the second blank line.

Alabama Service Calculation ERS S FC Step 3: Enter your registration number on the third blank line.

Alabama Service Calculation ERS S FC Step 4: Enter your street address or P.O. box number, city, state and zip code on the fourth blank line.

Alabama Service Calculation ERS S FC Step 5: The remainder of the form is to be completed by the employing agency, not the employee. Two tables are provided to document service. In the first column of each table, the dates being covered are listed. In the second column, the total salary paid during that period should be entered. In the third column, the dates of service for that period should be entered. In the fourth column, the number of months of service should be entered. Provide this information for all applicable dates.

Alabama Service Calculation ERS S FC Step 6: Check the first box below the tables if this form is being filed to establish retirement credit for full-time hourly rate employment.

Alabama Service Calculation ERS S FC Step 7: Check the second box if this form is being filed to establish retirement credit for part-time employment on a percentage basis. Enter the percentage.

Alabama Service Calculation ERS S FC Step 8: Check the third box if this form is being filed to establish retirement credit for provisional (non-temporary) employment.

Alabama Service Calculation ERS S FC Step 9: Check the fourth box if this form is being filed to establish retirement credit for full-time employment during a period of non-enrollment due to administrative error.

Alabama Service Calculation ERS S FC Step 10: Check the fifth box if this form is being filed to establish retirement credit as an elected official. Specify the office. If "other," check the sixth box and explain.

Alabama Service Calculation ERS S FC Step 11: The certifying official should enter their signature and title, the date, and the name of the agency.

INSTRUCTIONS: ALABAMA MULTIPLE BENEFICIARIES ATTACHMENT DEFERRED RETIREMENT OPTION PLAN (DROP) (Form ERA 10 DMB)

Alabama public employees who are enrolled in the state-administered Deferred Retirement Option Plan (DROP) can use the form discussed in this article to designate multiple beneficiaries who will receive their benefits in the event of their death. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Multiple Beneficiaries Attachment Deferred Retirement Option Plan (DROP) ERA 10 DMB Step 1: Enter your full name on the first blank line.

Alabama Multiple Beneficiaries Attachment Deferred Retirement Option Plan (DROP) ERA 10 DMB Step 2: Enter your Social Security number on the second blank line.

Alabama Multiple Beneficiaries Attachment Deferred Retirement Option Plan (DROP) ERA 10 DMB Step 3: In the table provided, you may document up to eight beneficiaries. Under Alabama law, benefits will be disbursed on a "joint survivorship" basis among all the beneficiaries. Enter the first name, middle or maiden name and last name of each beneficiary in the first column.

Alabama Multiple Beneficiaries Attachment Deferred Retirement Option Plan (DROP) ERA 10 DMB Step 4: Enter the date of birth of each beneficiary in the second column.

Alabama Multiple Beneficiaries Attachment Deferred Retirement Option Plan (DROP) ERA 10 DMB Step 5: Enter the address of each beneficiary in the third column.

Alabama Multiple Beneficiaries Attachment Deferred Retirement Option Plan (DROP) ERA 10 DMB Step 6: Enter each beneficiary's relationship to you in the fourth column.

Alabama Multiple Beneficiaries Attachment Deferred Retirement Option Plan (DROP) ERA 10 DMB Step 7: Check the first statement if the designated beneficiaries above are different from those listed on your active account and you wish for the change to become effective upon the submission of this signed and mailed application to the Employees' Retirement System Of Alabama.

Alabama Multiple Beneficiaries Attachment Deferred Retirement Option Plan (DROP) ERA 10 DMB Step 8: Check the second statement if the designated beneficiaries above are different from those listed on your active account and you wish for the change to become effective on the date your DROP participation begins.

Alabama Multiple Beneficiaries Attachment Deferred Retirement Option Plan (DROP) ERA 10 DMB Step 9: Enter your signature on the last blank line. Have the form certified by a notary public.

INSTRUCTIONS: ALABAMA DEFERRED RETIREMENT OPTION PLAN (DROP) PARTICIPATION PERIOD COMPLETED/CONTINUED SERVICE (Form TRS 10 D-CCE)

Members of the Teachers' Retirement System of Alabama may choose to terminate their enrollment in the Deferred Retirement Option Plan (DROP) following the completion of a participation period by filing the form discussed in this article. This document can be obtained from the website of the Retirement Systems of Alabama.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service TRS 10 D-CCE Step 1: On the first blank line, enter your first, middle and last name.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service TRS 10 D-CCE Step 2: On the second blank line, enter your Social Security number.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service TRS 10 D-CCE Step 3: On the third blank line, enter your employing school system or agency.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service TRS 10 D-CCE Step 4: On the fourth blank line, enter your requested effective date of DROP termination.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service TRS 10 D-CCE Step 5: On the fifth blank line, enter your phone number.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service TRS 10 D-CCE Step 6: If you will continue to be employed on a full-time basis after DROP termination, check the box on line I.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service TRS 10 D-CCE Step 7: On line II, enter your signature.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service TRS 10 D-CCE Step 8: Section III is for completion by your employer. On line 1, they will enter your last date of service prior to the DROP termination date.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service TRS 10 D-CCE Step 9: Your closing date of the last payroll for salary earned prior to the DROP termination date will be entered on line 2, your total accrued unused sick leave days on line 3, your current contract salary on line 4, your days worked prior to DROP termination on line 5, the days in your current contract period on line 6 and the authorized official's signature on line 7. Have the form certified by a notary.

INSTRUCTIONS: ALABAMA RETIREE EMPLOYMENT VERIFICATION (Form PEEHIP REV)

A form PEEHIP REV is used to verify the employment statue of a retiree enrolled in the Alabama Public Education Employees' Health Insurance Plan (PEEHIP). This document can be obtained from the website of the Retirement Systems of Alabama.

Alabama Retiree Employment Verification PEEHIP REV Step 1: The first section concerns the PEEHIP subscriber. On the first line, enter the subscriber's Social Security number, first name, middle name or initial and last name.

Alabama Retiree Employment Verification PEEHIP REV Step 2: On the second line, enter the subscriber's mailing address, city, state and zip code.

Alabama Retiree Employment Verification PEEHIP REV Step 3: On the third line, enter the subscriber's home phone number.

Alabama Retiree Employment Verification PEEHIP REV Step 4: The next section concerns your employment. Indicate with a check mark whether you are employed. If no, skip to the Medicare section beneath.

Alabama Retiree Employment Verification PEEHIP REV Step 5: On the first line, enter the name of your current employer, their phone number, and your date of hire.

Alabama Retiree Employment Verification PEEHIP REV Step 6: On the second line, enter your employer's address, city, state and zip code.

Alabama Retiree Employment Verification PEEHIP REV Step 7: Indicate whether your employer offers group health insurance with a check mark. If no, skip to the Medicare section below.

Alabama Retiree Employment Verification PEEHIP REV Step 8: Indicate whether your employer contributes at least 50% or more of single health insurance coverage for employees. If no, skip to the Medicare section below.

Alabama Retiree Employment Verification PEEHIP REV Step 9: Indicate whether you are eligible for your employer's group health insurance coverage with a check mark. If yes, enter the date on which you are eligible. If no, explain.

Alabama Retiree Employment Verification PEEHIP REV Step 10: The next section concerns Medicare. Indicate whether you are eligible with a check mark.

Alabama Retiree Employment Verification PEEHIP REV Step 11: If you or your dependents are eligible for Medicare, the next section must be completed. Enter the name, Medicare card number, and effective date for the subscriber. Additionally, indicate with a check mark whether you are eligible for Part A, Part B or Part D.

Alabama Retiree Employment Verification PEEHIP REV Step 12: Sign and date the form where indicated.

INSTRUCTIONS: APPLICATION TO TRANSFER OR REDEEM SERVICE CREDITS BETWEEN ARIZONA RETIREMENT PLANS (Form U2)

Public safety personnel, corrections officers and elected officials in Arizona can all use a form U2 in order to request that service credits from another retirement service or plan in the state be transferred to their current plan. This document can be obtained from the website maintained by the Elected Officials' Retirement Plan of the State of Arizona.

Application To Transfer Or Redeem Service Credits Between Arizona Retirement Plans U2 Step 1: On the first line of section I, enter your name.

Application To Transfer Or Redeem Service Credits Between Arizona Retirement Plans U2 Step 2: On the second line, enter your telephone number.

Application To Transfer Or Redeem Service Credits Between Arizona Retirement Plans U2 Step 3: On the third line, enter your complete address.

Application To Transfer Or Redeem Service Credits Between Arizona Retirement Plans U2 Step 4: On the fourth line, enter your Social Security number.

Application To Transfer Or Redeem Service Credits Between Arizona Retirement Plans U2 Step 5: On the fifth line, enter your date of birth.

Application To Transfer Or Redeem Service Credits Between Arizona Retirement Plans U2 Step 6: On the first line of section II, enter the name of your former retirement system or plan.

Application To Transfer Or Redeem Service Credits Between Arizona Retirement Plans U2 Step 7: On the second line, enter the name of your former employer while contributing to this plan.

Application To Transfer Or Redeem Service Credits Between Arizona Retirement Plans U2 Step 8: On the third line, enter your former position or classification.

Application To Transfer Or Redeem Service Credits Between Arizona Retirement Plans U2 Step 9: On the fourth and fifth lines, enter your beginning and ending previous service dates.

Application To Transfer Or Redeem Service Credits Between Arizona Retirement Plans U2 Step 10: Indicate with a check mark whether you withdrew member contributions from your previous plan. If redeeming refunded credit, enter how many months you wish to have calculated.

Application To Transfer Or Redeem Service Credits Between Arizona Retirement Plans U2 Step 11: In section III, enter your current retirement system or plan, current employer, service date, and current position or classification. 

Application To Transfer Or Redeem Service Credits Between Arizona Retirement Plans U2 Step 12: Sign and date the bottom of the page.

INSTRUCTIONS: ALABAMA DEFERRED RETIREMENT OPTION PLAN (DROP) PARTICIPATION PERIOD COMPLETED REQUEST FOR DROP TERMINATION (Form ERS 10 D-C)