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RSA 7 Notice of Final Deposit and Request for Refund

RSA 7 Notice of Final Deposit and Request for Refund

 

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

 

 

Alabama state employees who are terminating their employment and are not seeking employment with another agency can file a form RSA 7 to make their final deposit and request a refund. This document can be obtained from the website of the Retirement Systems of Alabama.

 

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 1: Part I requests information about you. 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 on the eighth blank line if known.

 

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 9: In Part II, indicate with a check mark whether you wish to receive your refund as a lump-sum payment or as a direct rollover giving a percentage of the taxable benefit of your specification to a trustee. If the latter, provide all identifying information requested about them and obtain the signature of a trustee official.

 

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 10: Sign and date the bottom of the first page. The bottom portion of the page should be completed by a notary public.

 

Alabama Notice Of Final Deposit And Request For Refund RSA 7 Step 11: Part III should be completed by the payroll official of your employer. 

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Authorization To Release Information

Authorization To Release Information

 

INSTRUCTIONS: ARIZONA AUTHORIZATION FOR RELEASE OF INFORMATION 

 

 

To permit the Arizona retirement funds for public safety personnel, corrections officers or elected officials to release your Social Security number to the Internal Revenue Service, you must file the document discussed in this article. This authorization form can be obtained from the website maintained by the Public Safety Personnel Retirement System.

 

Arizona Authorization For Release Of Information Step 1: In the first box of section 1, enter your Social Security number. You have the option of only entering the last four digits of your Social Security number.

 

Arizona Authorization For Release Of Information Step 2: Enter your SYSID, if known, in the second box.

 

Arizona Authorization For Release Of Information Step 3: In the third box, indicate with a check mark whether you are retired, non-retired or a survivor/guardian.

 

Arizona Authorization For Release Of Information Step 4: Enter your last name in the fourth box, your first name in the fifth box, and your first name in the sixth box.

 

Arizona Authorization For Release Of Information Step 5: Enter your full address in the seventh box.

 

Arizona Authorization For Release Of Information Step 6: Enter your email address in the eighth box.

 

Arizona Authorization For Release Of Information Step 7: Enter your home telephone number in the ninth box, your cell phone number in the tenth box, and your work phone number in the eleventh box.

 

Arizona Authorization For Release Of Information Step 8: In the first box of Section 2, enter the name of the person or organization representative to whom you are authorizing the release of this information. 

 

Arizona Authorization For Release Of Information Step 9: In the second box, enter their email address.

 

Arizona Authorization For Release Of Information Step 10: In the third box, enter the name of the organization.

 

Arizona Authorization For Release Of Information Step 11: In the fourth box, enter the street address of the person or organization.

 

Arizona Authorization For Release Of Information Step 12: In the fifth box, enter their telephone number.

 

Arizona Authorization For Release Of Information Step 13: In the sixth box, enter their fax number.

 

Arizona Authorization For Release Of Information Step 14: Sign the first box in section 4.

 

Arizona Authorization For Release Of Information Step 15: Enter the date in the second box of section 4.

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Application and Certification for Out of State Service Credit

Application and Certification for Out of State Service Credit

 

INSTRUCTIONS: ALABAMA APPLICATION AND CERTIFICATION FOR OUT-OF-STATE SERVICE CREDIT (Form RSA 50B)
 
 
Any contributing and active member of the Alabama Teachers' Retirement System (TRS) who has been enrolled for at least 10 years may use a form RSA 50B to purchase out-of-state service credit for service performed in another state's public schools or public employment. This document can be found on the website of the Retirement Systems of Alabama.
 
Alabama Application And Certification For Out-Of-State Service Credit RSA 50B Step 1: On the first line of Part I, enter your full name. On the second line, enter your date of birth.
 
Alabama Application And Certification For Out-Of-State Service Credit RSA 50B Step 2: On the third line, enter your Social Security number. 
 
Alabama Application And Certification For Out-Of-State Service Credit RSA 50B Step 3: On the fourth line, enter your home phone number.
 
Alabama Application And Certification For Out-Of-State Service Credit RSA 50B Step 4: On the fifth line, enter your street address or PO box number.
 
Alabama Application And Certification For Out-Of-State Service Credit RSA 50B Step 5: On the sixth line, enter your work phone number.
 
Alabama Application And Certification For Out-Of-State Service Credit RSA 50B Step 6: On the seventh line, enter your city, state and zip code. 
 
Alabama Application And Certification For Out-Of-State Service Credit RSA 50B Step 7: If known, enter your RSA account number on the eighth line.
 
Alabama Application And Certification For Out-Of-State Service Credit RSA 50B Step 8: On the next five lines, answer all questions about your former out-of-state employers. A separate form must be submitted for each separate out-of-state employer. Sign where indicated.
 
Alabama Application And Certification For Out-Of-State Service Credit RSA 50B Step 9: Complete the table in Part II. Enter the name of the employing unit in the first column, the number of months worked in the second column, the beginning and ending dates of the term of service in the third column, the length of the contract year in the fourth column, and the time base in the fifth column.
 
Alabama Application And Certification For Out-Of-State Service Credit RSA 50B Step 10: If you received credit from any supplemental retirement or pension plan wholly or fully funded by a public entity other than Social Security, give its name. Forward the form to the applicable out-of-state retirement system.
 

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General Statement of Service

General Statement of Service

 

INSTRUCTIONS: ALABAMA GENERAL STATEMENT OF SERVICE

 

 

When Alabama state employees are preparing to retire, one of the forms which must be filed in order to purchase services to be credited to their retirement account is a general statement of service. This document can be found on the website maintained by the Employees' Retirement System of Alabama.

 

Alabama General Statement Of Service Step 1: On the first blank line, enter your first, middle and last name.

 

Alabama General Statement Of Service Step 2: On the second blank line, enter your post office box number or your street address.

 

Alabama General Statement Of Service Step 3: On the third blank line, enter your city, state and zip code.

 

Alabama General Statement Of Service Step 4: On the fourth blank line, enter your Social Security number.

 

Alabama General Statement Of Service Step 5: Two statements are provided below. You should only check the box next to the statement applicable to you. The first statement should be checked if you have not established credit with any other public retirement service based on the service being claimed as a credit with the Employees' Retirement System of Alabama. By checking this statement, you also agree to notify the Employees' Retirement System of Alabama if you become entitled to credits or benefits for these services with any other public retirement plan when your entire, and that if you take these credits or benefits, your purchased service credit will be withdrawn and refunded to you.

 

Alabama General Statement Of Service Step 6: Check the box next to the second statement if you have established another public retirement system credit based on the service for which you are claiming credit with the Employees' Retirement System of Alabama.

 

Alabama General Statement Of Service Step 7: Provide your signature and the date in the blank lines where indicated.

 

Alabama General Statement Of Service Step 8: The form must then be certified by a licensed notary public. They will enter your state and county, the date on which you appear before them and your name. They will then sign the form, enter the date on which their commission expires, and affix their seal.

 

Alabama General Statement Of Service Step 9: File the form by mailing it to the address provided at the top of the form.

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Form ERS100 ERS Enrollment Member Information Record

Form ERS100 ERS Enrollment Member Information Record

 

INSTRUCTIONS: ALABAMA ERS ENROLLMENT MEMBER INFORMATION RECORD (Form ERS 100)

 

 

When enrolling in the Alabama Employees' Retirement System, form ERS 100 is used to provide a record of your information. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 1: Indicate whether you are a new member or transferring from another Employees' Retirement System with a check mark.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 2: On the first blank line, enter your full name.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 3: On the second blank line, enter your Social Security number.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 4: Indicate your sex with a check mark.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 5: Indicate your marital status with a check mark.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 6: Enter your Social Security number on the third blank line.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 7: Enter your date of birth on the fourth blank line.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 8: Enter your street address or P.O. box, city, state and zip code on the fifth blank line.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 9: Enter your phone number on the sixth blank line.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 10: Enter the classification or title of the position or elected office you hold on the seventh blank line.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 11: Enter your employing agency on the eighth blank line.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 12: Enter your section or division on the ninth blank line.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 13: Answer the next five questions by checking "yes" or "no" as applicable.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 14: If you answered yes to any of the preceding five questions, complete the table below.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 15: Sign and date the form on the next two blank lines.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 16: Submit the form to your employing agency for completion.

 

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Form RSA WCPAP Withholding Certificate for Pension or Annuity Payments

Form RSA WCPAP Withholding Certificate for Pension or Annuity Payments

 

INSTRUCTIONS: ALABAMA WITHHOLDING CERTIFICATE FOR PENSION OR ANNUITY PAYMENTS (Form RSA WCPAP)

 

 

To document your wishes regarding withholding federal tax deductions from monthly pensions or annuities administered by the Retirement Systems of Alabama, file the form discussed in this article. This document can be obtained from the website of the Retirement Systems of Alabama.

 

Alabama Withholding Certificate For Pension Or Annuity Payments RSA WCPAP Step 1: Enter the member's name on the first blank line.

 

Alabama Withholding Certificate For Pension Or Annuity Payments RSA WCPAP Step 2: Enter the member's Social Security number on the second blank line.

 

Alabama Withholding Certificate For Pension Or Annuity Payments RSA WCPAP Step 3: Check the box on line 1 if you do not wish to have federal tax deductions withheld from monthly pensions or annuities. If this is the case, do not complete any other areas of this form other than signing and dating the bottom of the page.


Alabama Withholding Certificate For Pension Or Annuity Payments RSA WCPAP Step 4: Check the box on line 2 if you wish to have federal withholding tax calculated using your marital status and the number of exemptions being claimed.

 

Alabama Withholding Certificate For Pension Or Annuity Payments RSA WCPAP Step 5: Indicate your marital status with a check mark on line A.

 

Alabama Withholding Certificate For Pension Or Annuity Payments RSA WCPAP Step 6: Enter the total number of exemptions being claimed on line B. If left blank, it will be assumed you meant 0.

 

Alabama Withholding Certificate For Pension Or Annuity Payments RSA WCPAP Step 7: Check the box on line 3 if you wish to have an amount withheld from your monthly pension or annuity payments greater than the amount on the tax tables. 

 

Alabama Withholding Certificate For Pension Or Annuity Payments RSA WCPAP Step 8: Indicate your marital status with a check mark on line A.

 

Alabama Withholding Certificate For Pension Or Annuity Payments RSA WCPAP Step 9: Enter the total exemptions being claimed on line B.

 

Alabama Withholding Certificate For Pension Or Annuity Payments RSA WCPAP Step 10: Check the box on line 4 if you want an additional amount withheld. Enter the amount, note your marital status on line A with a check mark, and enter the total exemptions being claimed on line B. Enter your signature and the date at the bottom of the page.

 

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Form RSA-1 EN RSA-1 Enrollment RSA-1 Deferred Compensation Plan

Form RSA-1 EN RSA-1 Enrollment RSA-1 Deferred Compensation Plan

 

INSTRUCTIONS: ALABAMA RSA-1 ENROLLMENT (Form RSA-1 EN)

 

 

Alabama employees can enroll in the state-administered RSA-1 deferred compensation plan by filing the form discussed in this article. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 1: Enter your first name, middle or maiden name and last name on the first blank line.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 2: Enter your street address or P.O. box number on the second blank line.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 3: Enter your city, state or zip code on the third blank line.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 4: Enter your Social Security number on the fourth blank line.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 5: Enter your date of birth on the fifth blank line.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 6: Indicate your sex with a check mark.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 7: Enter your phone number, including the area code, on the sixth blank line.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 8: Enter your email address on the seventh blank line.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 9: Enter the name of your employing agency on the eighth blank line.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 10: Enter your employer phone number on the ninth blank line.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 11: Check the first statement if currently enrolled in the Employees' Retirement System (ERS).

 

Alabama RSA-1 Enrollment RSA-1 EN Step 12: Check the second statement if currently enrolled in the Judicial Retirement Fund (JRF).

 

Alabama RSA-1 Enrollment RSA-1 EN Step 13: Check the third statement if currently enrolled in the Teachers' Retirement System (TRS).

 

Alabama RSA-1 Enrollment RSA-1 EN Step 14: Check the fourth statement if not currently enrolled in the ERS, TRS or JRF.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 15: Read the statements printed on the bottom half of the page. These include information about other forms which must be submitted in addition with this enrollment form.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 16: Enter your signature on the next blank line.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 17: Enter the date on the last blank line.

 

Alabama RSA-1 Enrollment RSA-1 EN Step 18: Submit the form to the address given at the top of the page.

 

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Form RSA-1 EN IOE 457 Transfer Investment Option Election for Incoming 457 Transfer

Form RSA-1 EN IOE 457 Transfer Investment Option Election for Incoming 457 Transfer

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Annual Investment Option Election for DROP Rollover or 457 Transfer

Annual Investment Option Election for DROP Rollover or 457 Transfer

 

INSTRUCTIONS: ALABAMA ANNUAL INVESTMENT OPTION ELECTION DROP ROLLOVER OR 457 TRANSFER (Form RSA-1 IOE)
 
Alabama public employees enrolled in the DROP or section 457 retirement plans can use a form RSA-1 IOE to annually declare how much they wish of their funds to be invested in fixed or stock investment options. This document can be obtained from the website of the Retirement Systems of Alabama.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step 1: Indicate with a check mark whether you are performing a DROP rollover or a 457 transfer.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step 2: On the first blank line, enter your full name.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step 3: On the second blank line, enter your Social Security number.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  4: On the third blank line, enter your date of birth.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  5: If you are the beneficiary of a deceased person, complete the next three lines, Otherwise, leave these blank. 
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  6: Enter your street address, email address and home phone number where indicated.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  7: Check only one of the four listed options regarding your account. Check the box next to the first statement to set a percentage of your fixed investment to be transferred to stocks and write the percentage.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  8: Check the box next to the second statement to set a dollar amount of your fixed investment to be transferred to a stock investment and write the dollar amount.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  9: Check the box next to the third statement to transfer a percentage of your stock investment to a fixed investment option and write the percentage.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  10: Check the box next to the fourth statement to transfer a dollar amount of your stock investment to a fixed investment and write the amount. 
 

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Public Records Inspection or Reproduction Request Form

Public Records Inspection or Reproduction Request Form

 

INSTRUCTIONS: ARIZONA PUBLIC RECORDS INSPECTION OR REPRODUCTION REQUEST FORM 

 

 

To request an inspection or copies of Arizona public records in the care of the state retirement plans for public safety personnel, corrections officers or elected officials, you may file the form discussed in this document. This form can be obtained from the website maintained by the website of the Public Safety Personnel Retirement System of Arizona.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 1: Check the first box if you are requesting a record inspection without any copies being made.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 2: If you are seeking copies of these documents, check the box next to the applicable statement. Check the first box if requesting paper copies.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 3: Check the second box if requesting computer printouts.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 4: Check the third box if requesting electronic copies.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 5: In the table provided, enter the records you are seeking to inspect or receive copies of.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 6: Check the next box if you are requesting these records for an intended commercial purpose. If so, provide a brief explanation in the box provided. If approved, the charge for these copies will reserve a portion of the cost for the public body which obtained the original documents, as well as including a reasonable fee for the labor and materials involved in reproduction and a fee for the current market value of the reproduction.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 7: Sign your name on the first blank line at the bottom of the page.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 8: Print your name on the second blank line.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 9: Enter your company name on the third blank line.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 10: Enter your street address on the fourth blank line.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 11: Enter your city, state and zip code on the fifth blank line.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 12: Enter your phone number, fax number and email address on the sixth blank line.

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