Withholding Certificate for Pension or Annuity Payments

INSTRUCTIONS: ALABAMA WITHHOLDING INSTRUCTIONS FOR PENSION OR ANNUITY PAYMENTS

Alabama public employees who are enrolled in a state-administered monthly pension or annuity are required to file instructions documenting their wishes concerning federal withholding tax. Failure to file this form will result in taxes being withheld on rates commensurate with married individuals with three exemptions. This document can be found on the website of the Retirement Systems of Alabama.

Alabama Withholding Instructions For Pension Or Annuity Payments Step 1: On the first blank line, enter your name.

Alabama Withholding Instructions For Pension Or Annuity Payments Step 2: On the second blank line, enter your Social Security number.

Alabama Withholding Instructions For Pension Or Annuity Payments Step 3: Check the box next to the first statement if you do not want to have federal withholding tax deducted from your monthly pension or annuity. Note that this will make you liable for all tax payments, including potential penalties if your payments are not sufficient. If you check this box, you do not need to complete the remainder of the form.

Alabama Withholding Instructions For Pension Or Annuity Payments Step 4: Check the box next to the second statement if you wish to have your withholding tax calculated on the basis of your marital status and number of exemptions claimed. If so, indicate your marital status with a checkmark on line A and enter the total number of exemptions claimed on line B.

Alabama Withholding Instructions For Pension Or Annuity Payments Step 5: Check the box next to the third statement if you wish to have an amount greater than required by the tax tables withheld from your monthly pension or annuity. If so, enter the dollar amount. Indicate your marital status with a checkmark on line A and enter the total number of exemptions claimed on line B.

Alabama Withholding Instructions For Pension Or Annuity Payments Step 6: If you wish to have an additional amount withheld, check the box next to the fourth statement and enter the dollar amount. Indicate your marital status using a checkmark on line A and enter the total number of exemptions you will claim on line B.

Alabama Withholding Instructions For Pension Or Annuity Payments Step 7: Sign and date the bottom of the page where indicated.

Beneficiary Designation

INSTRUCTIONS: ALABAMA BENEFICIARY DESIGNATION RSA-1 AND PEIRAF

Alabama public employees enrolled in either the RSA-1 or PEIRAF retirement funds should file a beneficiary designation to appoint beneficiaries to whom funds will be disbursed in the event of their death. This beneficiary designation form can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 1: At the top left-hand corner, indicate with a check mark whether you are enrolled in the RSA-1 or PEIRAF program.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 2: On the first blank line, enter your first name, middle or maiden name and last name.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 3; On the second blank line, enter your street address or PO box number.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 4: On the third blank line, enter your city, state and zip code.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 5: On the fourth blank line, enter your Social Security number.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 6: On the fifth blank line, enter your phone number.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 7; If you are including beneficiary information on both sides of the page, check the line stating so.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 8: The first section allows you to name up to three primary beneficiaries who will receive your benefits providing they survive you. The format for naming each beneficiary. In the first blank line for each primary beneficiary, enter their name.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 9: In the second blank line for each primary beneficiary, enter their relationship to you.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 10: In the third blank line for each primary beneficiary, enter their date of birth.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 11: In the fourth blank line for each primary beneficiary, enter their Social Security number.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 12: In the fifth blank line for each primary beneficiary, enter their address.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 13: Follow the same format to name all contingent beneficiaries who will inherit in case your primary beneficiaries do not survive you.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 14: Sign and date the form before a notary public.

Special Catch-Up Election and Worksheet

INSTRUCTIONS: ALABAMA SPECIAL CATCH-UP ELECTION AND WORKSHEET (Form RSA-1 CATCH UP)

Alabama public employees who are enrolled in the RSA-1 retirement fund plan can use an RSA-1 Catch Up worksheet to make catch-up deferrals for years in which they failed to contribute the maximum possible to the retirement fund. This can be done in the three years prior to Normal Retirement Age. This form can be found on the website of the Retirement Systems of Alabama.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 1: At the top of the first page, enter your name, address, Social Security number, phone number, date of birth and email address.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 2: In the next section labeled "Special Catch-Up Election," enter the age you are designating your Normal Retirement Age and the year in which you will be this age.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 3: In the section labeled "Employee Certification," enter the name of your current employer and their address. Sign and date the bottom of this page.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 4: Complete the worksheet on the second and third pages. The first column lists every calendar year from 1986 to 2011. For each year for which you did not pay the maximum deferrable amount, enter your gross income as documented on your W-2 for that year in column B.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 5: Enter the amount contributed to your RSA-1 fund that year in column C.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 6: Subtract column C from column B. Enter the difference in column D.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 7: Consult the instructions for "Step 5" on the page to determine what figure should be entered in column E.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 8: In column F, enter the amount deferred to retirement funds in that year.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 9: Subtract column F from column E. Enter the difference in column G. This determines how much you can make in catch-up payments for that year. Transfer this information to the chart at the bottom of the page.

Form E6: Application for a Separation Benefit/Deferred Benefit

INSTRUCTIONS: ARIZONA APPLICATION FOR A SEPARATION BENEFIT/DEFERRED BENEFIT (Form E6)

Arizona elected public officials who terminate their employment may either apply for a refund of money contributed to their state-administered retirement plan or apply to have benefits deferred until they are of age to collect. These requests are made using a form E6. This document can be obtained from the website of the Elected Officials' Retirement Plan of the State of Arizona.

Arizona Application For A Separation Benefit/Deferred Benefit E6 Step 1: Enter your name on the first line.

Arizona Application For A Separation Benefit/Deferred Benefit E6 Step 2: Enter your Social Security number on the second line.

Arizona Application For A Separation Benefit/Deferred Benefit E6 Step 3: Enter your street address, as well as your apartment number (if applicable) on the third line.

Arizona Application For A Separation Benefit/Deferred Benefit E6 Step 4: Enter your city, state and zip code on the fourth line.

Arizona Application For A Separation Benefit/Deferred Benefit E6 Step 5: Enter your phone number on the fifth line.

Arizona Application For A Separation Benefit/Deferred Benefit E6 Step 6: Enter your birth date on the sixth line.

Arizona Application For A Separation Benefit/Deferred Benefit E6 Step 7: Enter the name of your office on the seventh line.

Arizona Application For A Separation Benefit/Deferred Benefit E6 Step 8: Enter the beginning date of your employment in this office on the eighth line.

Arizona Application For A Separation Benefit/Deferred Benefit E6 Step 9: Enter the termination date of your employment in this office on the ninth line.

Arizona Application For A Separation Benefit/Deferred Benefit E6 Step 10: If you place your initials on the blank line in the section labeled "Refund Option," you are requesting a refund of contributions to the elected officials' retirement plan.

Arizona Application For A Separation Benefit/Deferred Benefit E6 Step 11: If you place your initials on the blank line in the section labeled "Deferred Pension Office," you are leaving your credits on deposit in anticipation of collection when eligible.

Arizona Application For A Separation Benefit/Deferred Benefit E6 Step 12: You must initial the next blank line.

Arizona Application For A Separation Benefit/Deferred Benefit E6 Step 13: Sign and date the bottom of the first page. Have your governing authority complete the certification of termination on the second page.

Authorization For Release Of Information

Investment Option Election for New Accounts

INSTRUCTIONS: ALABAMA INVESTMENT OPTION ELECTION FOR NEW ACCOUNTS (Form RSA-1 EN IOE)

Alabama public employees enrolled either in the RSA-1 or DROP retirement funds may elect to have part or all of their fund invested in stocks rather than fixed investments. This is done by filing a form RSA-1 EN IOE. This document can be obtained from the website of the Retirement Systems of Alabama and can be filed once a year.

Alabama Investment Option Election For New Accounts RSA-1 EN IOE Step 1: At the top left-hand corner, indicate with a check mark whether you are enrolled in the RSA-1 or DROP program.

Alabama Investment Option Election For New Accounts RSA-1 EN IOE Step 2: On the first blank line, enter your first, middle and last name.

Alabama Investment Option Election For New Accounts RSA-1 EN IOE Step 3: On the second blank line, enter your street address or PO box number.

Alabama Investment Option Election For New Accounts RSA-1 EN IOE Step 4: On the third blank line, enter your city, state and zip code.

Alabama Investment Option Election For New Accounts RSA-1 EN IOE Step 5: On the fourth blank line, enter your Social Security number.

Alabama Investment Option Election For New Accounts RSA-1 EN IOE Step 6: On the fifth blank line, enter your date of birth.

Alabama Investment Option Election For New Accounts RSA-1 EN IOE Step 7: On the sixth blank line, enter your phone number.

Alabama Investment Option Election For New Accounts RSA-1 EN IOE Step 8: The next section is only for those with RSA-1 accounts. Write what percentage of your fund you wish to have in a fixed investment option where indicated and what percentage you wish to have invested in stocks. Both percentages must add up to 100%.

Alabama Investment Option Election For New Accounts RSA-1 EN IOE Step 9: The next section is only for those with DROP accounts. Indicate what percentage of your account you wish to have in a fixed investment option and what percentage you wish to have invested in stocks. Both percentages must add up to 100%.

Alabama Investment Option Election For New Accounts RSA-1 EN IOE Step 10: Sign and date the bottom of the page in the presence of a notary public. Mail it to the address given at the top of the page.

RSA 100-C Change of Beneficiary Form – Prior to Retirement

RSA 100-C Change of Beneficiary Form - Prior to Retirement

INSTRUCTIONS: ALABAMA CHANGE OF BENEFICIARY FORM PRIOR TO RETIREMENT (Form RSA 100-C)

Prior to your retirement, if you wish to change the beneficiaries who will receive the accumulated credits from your contributions to your Alabama retirement fund as a state employee in the event of your death, you may do so by filing a form RSA 100-C. This document can be obtained from the website of the Retirement Systems of Alabama. Print or type your answers in black ink. Note that this form should not be used by those who are retired or participants in the DROP program.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 1: Enter your name and Social Security number.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 2: Enter your date of birth.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 3: Enter your home phone number.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 4: Indicate with a check mark if you are an active or inactive member.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 5: The section below is where you name your primary beneficiary. On the first line there, give their name.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 6: On the second line, state their relationship to you.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 7: On the third line, give their date of birth.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 8: On the fourth line, enter their Social Security number.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 9: On the fifth line, give their full address.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 10: You may name additional primary beneficiaries on the second page.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 11: The next section allows you to name a contingent beneficiary in the event that all of your primary beneficiaries are deceased. Provide their name, relationship to you, date of birth, Social Security number and address.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 12: You must sign and date the form in the presence of a notary public.

Form RSA SWDS Statement of Withdrawn Service

INSTRUCTIONS: ALABAMA STATEMENT OF WITHDRAWN SERVICE (Form RSA SWDS)

For previously withdrawn service to be credited to a retirement account administered by the Retirement Systems of Alabama, the form discussed in this article must be filed. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Statement Of Withdrawn Service RSA SWDS Step 1: Enter your first, middle and last name on the first blank line.

Alabama Statement Of Withdrawn Service RSA SWDS Step 2: Enter your address on the second blank line.

Alabama Statement Of Withdrawn Service RSA SWDS Step 3: Enter your Social Security number on the third blank line.

Alabama Statement Of Withdrawn Service RSA SWDS Step 4: Place a check mark next to the first statement if you have not established any other public retirement system credit for previously withdrawn service.

Alabama Statement Of Withdrawn Service RSA SWDS Step 5: Place a check mark next to the second statement if you have established another public retirement system credit for previously withdrawn service.

Alabama Statement Of Withdrawn Service RSA SWDS Step 6: Place a check mark next to the third statement if you have established credit with another public retirement system for part of your previously withdrawn service. Enter the total years and months of this service.

Alabama Statement Of Withdrawn Service RSA SWDS Step 7: Enter your signature on the next blank line.

Alabama Statement Of Withdrawn Service RSA SWDS Step 8: Enter your date on the next blank line.

Alabama Statement Of Withdrawn Service RSA SWDS Step 9: The form should then be certified by a notary public. On the first blank line, they will enter the state.

Alabama Statement Of Withdrawn Service RSA SWDS Step 10: On the second blank line, the notary public will enter the county.

Alabama Statement Of Withdrawn Service RSA SWDS Step 11: On the third blank line, the notary public will enter the number of the day.

Alabama Statement Of Withdrawn Service RSA SWDS Step 12: On the fourth blank line, the notary public will enter the month. On the fifth blank line, they will enter the month.

Alabama Statement Of Withdrawn Service RSA SWDS Step 13: On the sixth blank line, the notary public will enter your name. They will enter their signature and the date their commission expires on the last two blank lines.

Form RSA 7 Notice of Final Deposit and Request for Refund

INSTRUCTIONS: ALABAMA NOTICE OF FINAL DEPOSIT AND REQUEST FOR REFUND (Form RSA 7)

Alabama public employees enrolled in the state's Retirement Systems can use the form discussed in this article to give notice of their final deposit in these state retirement plans and request a refund of their benefits due. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 1: Part I concerns the member. Enter your name on the first blank line.

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 2: Enter your date of birth on the second blank line.

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 3: Enter your Social Security number on the third blank line.

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 4: Enter your home phone number on the fourth blank line.

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 5: Enter your street address or P.O. box number on the fifth blank line.

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 6: Enter your work phone number on the sixth blank line.

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 7: Enter your city, state and zip code on the seventh blank line.

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 8: Enter your RSA account number, if known, on the eighth blank line.

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 9: In Part II, check Part A if you wish to receive a lump sum payment of your full account minus the 20% which must be withheld for federal income tax payments.

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 10: Check Part B if you wish to have a direct rollover to a trustee named below. Enter the percentage of your account you wish to have transferred.

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 11: Provide all information requested about your trustee and the type of account your money will be transferred into. Sign and date the form. Have it certified by a notary public.

Retirement Application Packet Part I

INSTRUCTIONS: ALABAMA RETIREMENT APPLICATION PACKET PART I

Members of the Teachers' Retirement System Of Alabama can use the packet discussed in this article to begin the retirement process. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Retirement Application Packet Part I Step 1: The first page of this packet is a cover sheet outlining its contents.

Alabama Retirement Application Packet Part I Step 2: The second page contains a checklist of documents to be filed and steps to be taken as part of the retirement process.

Alabama Retirement Application Packet Part I Step 3: The third page contains the application for retirement, which is TRS form 10. The first section requires the member to provide information about themselves.

Alabama Retirement Application Packet Part I Step 4: The second section concerns the designation of beneficiaries in the event of your death.

Alabama Retirement Application Packet Part I Step 5: The third section requires the member to sign and date the form. A notary public must also affix their seal.

Alabama Retirement Application Packet Part I Step 6: The fourth section must be completed by the employer.

Alabama Retirement Application Packet Part I Step 7: The fourth page contains an insurance authorization form, which is form PEEHIP IA. Part I concerns continuation or discontinuation of PEEHIP Hospital/Medical coverage.

Alabama Retirement Application Packet Part I Step 8: Part II concerns your street address.

Alabama Retirement Application Packet Part I Step 9: Part III must be completed by your payroll or insurance official.

Alabama Retirement Application Packet Part I Step 10: Part IV is only for members who have enrolled for optional coverage.

Alabama Retirement Application Packet Part I Step 11: Part V is for those whose employer does not participate in PEEHIP Medical/Hospital coverage.

Alabama Retirement Application Packet Part I Step 12: Part VI concerns vested members who are not currently enrolled.

Alabama Retirement Application Packet Part I Step 13: The fifth and sixth pages contain a Direct Deposit Authorization Form, which is form RSA DDR. This document is used to authorize the direct deposit of retirement benefits into the account of a retiree or the beneficiary of a deceased retiree. Provide all information requested about the recipient on the first page. The financial institution must complete the second page.

Retirement

Judicial Retirement System

Firefighter Certification