Investment Option Election for 457 Transfers

INSTRUCTIONS: ALABAMA INVESTMENT OPTION ELECTION FOR INCOMING 457 TRANSFER

Alabama public employees wishing to arrange a transfer of an investment fund from one retirement trust to a section 457 retirement fund may do so once a year by filing the document discussed in this article. This form can only be filed once a year and will remain in effect for the entire year. This form can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Investment Option Election For Incoming 457 Transfer Step 1: On the first line, enter your first name, middle or maiden name, and last name.

Alabama Investment Option Election For Incoming 457 Transfer Step 2: On the second line, enter your street address or P.O. box number.

Alabama Investment Option Election For Incoming 457 Transfer Step 3: On the third line, enter your city, state and zip code.

Alabama Investment Option Election For Incoming 457 Transfer Step 4: On the fourth line, enter your Social Security number.

Alabama Investment Option Election For Incoming 457 Transfer Step 5: On the fifth line, enter your complete date of birth.

Alabama Investment Option Election For Incoming 457 Transfer Step 6: On the sixth line, enter your telephone number, including the area code..

Alabama Investment Option Election For Incoming 457 Transfer Step 7: The next section concerns section 457 transfer accounts. Check the box next to the first statement if you wish to have part or all of your trustee-to-trustee transfer funds invested in the RSA-1 fixed investment option. Write the percentage of funds you wish to have invested in this option.

Alabama Investment Option Election For Incoming 457 Transfer Step 8: Check the box next to the second statement if you wish to have part or all of your trustee-to-trustee transfer funds invested in the RSA-1 stock investment option. Write the percentage of funds you wish to have invested in this option.

Alabama Investment Option Election For Incoming 457 Transfer Step 9: The form should be signed and dated in the presence of a notary public.

Alabama Investment Option Election For Incoming 457 Transfer Step 10: File the document by mailing it to the address given at the top of the page. Note that you must file this document before these funds can be transferred.

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 EOSS: Out of State/Federal Service Affidavit

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.

Authorization to Defer Compensation

INSTRUCTIONS: ALABAMA AUTHORIZATION TO DEFER COMPENSATION (Form RSA-1 ADC)

Alabama public employees use a form RSA-1 ADC to authorize deferring compensation as part of new enrollment in the state RSA-1 retirement fund program or to modify the amount of compensation deferred. This document can be obtained from the website of the Retirement Systems of Alabama.

Alabama Authorization To Defer Compensation RSA-1 ADC Step 1: On the line labeled "From," enter your first, middle or maiden and last name.

Alabama Authorization To Defer Compensation RSA-1 ADC Step 2: On the next blank line, enter your Social Security number.

Alabama Authorization To Defer Compensation RSA-1 ADC Step 3: Check "New Enrollment" if you are enrolling in the RSA-1 program.

Alabama Authorization To Defer Compensation RSA-1 ADC Step 4: Check "Restart" if you are restarting your involvement in RSA-1.

Alabama Authorization To Defer Compensation RSA-1 ADC Step 5: Check "Increase Deferrals" if you wish to increase the amount of compensation to be deferred to your RSA-1 retirement fund.

Alabama Authorization To Defer Compensation RSA-1 ADC Step 6: Check "Decrease Deferrals" if you wish to decrease the amount of compensation to be deferred to your RSA-1 retirement fund.

Alabama Authorization To Defer Compensation RSA-1 ADC Step 7: Check "Sick/Annual Leave" if you wish to temporarily halt deferrals of compensation to your RSA-1 retirement fund for either of those reasons.

Alabama Authorization To Defer Compensation RSA-1 ADC Step 8: Check "Stop Deferrals" if you wish to cease deferrals of compensation to your retirement fund.

Alabama Authorization To Defer Compensation RSA-1 ADC Step 9: On the next blank line, enter the dollar amount you wish to have deferred per pay period to your RSA-1 retirement fund.

Alabama Authorization To Defer Compensation RSA-1 ADC Step 10: On the next blank line, enter the date on which you wish for these deferrals to take effect. Note that this date cannot be any earlier than the first of the month following the date on which this form is submitted.

Alabama Authorization To Defer Compensation RSA-1 ADC Step 11: Sign and date the bottom of the page.

Alabama Authorization To Defer Compensation RSA-1 ADC Step 12: If you are requesting cessation of deferrals of compensation on grounds of financial compensation, a payroll officer must also sign and date the form.

RSA SB PRDB, Application for Survivor Benefit

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.

ERS F Service Calculation

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.

Form ERS F SC Service Calculation

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.

Form ERS 10 DMB Designation of Multiple Beneficiaries for DROP

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.

Form TRS 10 D-CCE DROP Participation Period Completed/ Continued Service

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.

Retirement

Judicial Retirement System

Firefighter Certification