INSTRUCTIONS: ALABAMA STATEMENT OF WITHDRAWN SERVICE

Alabama state employees enrolled in either the Employees' Retirement System or the Teachers' Retirement System who have previously withdrawn their contributions can restore previously canceled credits by filing the form discussed in this article. This withdrawn service cannot be service credit which has been established with any other public retirement system. 

Alabama Statement Of Withdrawn Service Step 1: On the first blank line, enter your first, middle and last names.

Alabama Statement Of Withdrawn Service Step 2: On the second blank line, enter your complete address.

Alabama Statement Of Withdrawn Service Step 3: On the third blank line, enter your Social Security number.

Alabama Statement Of Withdrawn Service Step 4: Three statements are printed below. Place a check in the first set of blank parentheses if you have not established any other public retirement system credit utilizing previously withdrawn service.

Alabama Statement Of Withdrawn Service Step 5: Place a check in the second set of blank parentheses if you have established any other public retirement system credit utilizing previously withdrawn service.

Alabama Statement Of Withdrawn Service Step 6: Place a check in the third set of blank parentheses if you have established another public retirement system credit for part of your previously withdrawn service. Enter the number of years and months which have been transferred to this credit.

Alabama Statement Of Withdrawn Service Step 7: Enter your signature and the date. 

Alabama Statement Of Withdrawn Service Step 8: Once you have completed the form, it must be certified by a notary public. In the space below the solid line, they will enter the state and county, the date on which you appeared before them and your name. They will then sign the bottom of the form, provide the date on which their commission expires, and affix their seal.

Alabama Statement Of Withdrawn Service Step 9: File the form at the address given at the top of the form. 

Alabama Statement Of Withdrawn Service Step 10: Once your application has been processed, you will need to pay the cost of purchasing your previously withdrawn service. You will be assessed a fee of the amount previously withdrawn, along with eight percent interest compounded from the date of withdrawal to the date of payment. The total withdrawn payment must be made before your employment ceases.

INSTRUCTIONS: ALABAMA REPORT OF DISABILITY PACKET 

Alabama public employees enrolled in the state's Retirement Systems can use the packet discussed in this article to file for a disability benefit. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Report Of Disability Packet Step 1: The first page is a cover page.

Alabama Report Of Disability Packet Step 2: The second page contains general instructions for completion of this packet and explains who is eligible to file for a disability benefit. In order to qualify for this benefit, you must have at least 10 years of creditable service, be in-service and be determined to be permanently incapacitated for the further performance of duty by the RSA medical board.

Alabama Report Of Disability Packet Step 3: The third page contains Part I of form RSA PRD, a statement from an examining physician. At the top of this page, they will enter your name, Social Security number, address, sex, date of birth, email address, blood pressure, height, job classification, urinalysis and weight.

Alabama Report Of Disability Packet Step 4: The doctor will enter the date on which you came into their professional care and the date of their last examination.

Alabama Report Of Disability Packet Step 5: The physician will answer all questions about your health on the third and fourth pages. 

Alabama Report Of Disability Packet Step 6: At the bottom of the fourth page, the physician should print and sign their name, enter their address and phone number, their specialty, and the date of submission.

Alabama Report Of Disability Packet Step 7: The fifth page contains Part II, which is the applicant's authorization. Enter your name on the first blank line.

Alabama Report Of Disability Packet Step 8: Enter your Social Security number on the second blank line.

Alabama Report Of Disability Packet Step 9: Enter the date on the third blank line.

Alabama Report Of Disability Packet Step 10: Enter your physician's name on the fourth blank line.

Alabama Report Of Disability Packet Step 11: Enter your street address or P.O. box number on the fifth blank line.

Alabama Report Of Disability Packet Step 12: Enter your city, state and zip code on the sixth blank line.

Alabama Report Of Disability Packet Step 13: Indicate what you are applying for with a check mark. Sign the form and provide your address.

INSTRUCTIONS: ALABAMA STATEMENT OF MILITARY SERVICE (Form TRS SMS 1109)

New employees who become members of the Retirement Systems of Alabama may purchase up to four years of active duty military service credit based upon an honorable discharge. This is done using the form discussed in this article, which is available on the website maintained by the Retirement Systems of Alabama.

Alabama Statement Of Military Service TRS SMS 1109 Step 1: Enter your name on the first blank line.

Alabama Statement Of Military Service TRS SMS 1109 Step 2: Enter your Social Security number on the second blank line.

Alabama Statement Of Military Service TRS SMS 1109 Step 3: Enter your street address or P.O. box number on the third blank line.

Alabama Statement Of Military Service TRS SMS 1109 Step 4: Enter your city, state and zip code on the fourth blank line.

Alabama Statement Of Military Service TRS SMS 1109 Step 5: Check the box next to the first statement if you are receiving no benefits for your military service.

Alabama Statement Of Military Service TRS SMS 1109 Step 6: Check the box next to the second statement if you are receiving a service retirement benefit from a branch of the Armed Forces.

Alabama Statement Of Military Service TRS SMS 1109 Step 7: Check the box next to the third statement if you are receiving a service retirement benefit based partially on your military service from a source other than a branch of the Armed Forces. Specify the source.

Alabama Statement Of Military Service TRS SMS 1109 Step 8: Check the box next to the fourth statement if you are receiving a disability retirement benefit from a branch of the Armed Forces.

Alabama Statement Of Military Service TRS SMS 1109 Step 9: Check the box next to the fifth statement if you are receiving a disability retirement benefit based partially on your military service from a source other than a branch of the Armed Forces. Specify the sources.

Alabama Statement Of Military Service TRS SMS 1109 Step 10: Check the box next to the sixth statement if you received an honorable discharge.

Alabama Statement Of Military Service TRS SMS 1109 Step 11: Check the box next to the seventh statement if you did not receive an honorable discharge.

Alabama Statement Of Military Service TRS SMS 1109 Step 12: Sign and date the form.

INSTRUCTIONS: ALABAMA INCOMING TRANSFER FROM OTHER SECTION 457 PLANS TO RSA-1 (Form RSA-1 457)

To apply for a transfer from other section 457 plans to an RSA-1 fund managed by the Retirement Systems of Alabama as a state employee, file the document discussed in this article. This form can be obtained from the website of the Retirement Systems of Alabama.

Alabama Incoming Transfer From Other Section 457 Plans To RSA-1 RSA-1 457 Step 1: Part I concerns the member. On the first two blank lines, enter your name and Social Security number.

Alabama Incoming Transfer From Other Section 457 Plans To RSA-1 RSA-1 457 Step 2: On the next two blank lines, enter your home street address or P.O. box number, city, state and zip code.

Alabama Incoming Transfer From Other Section 457 Plans To RSA-1 RSA-1 457 Step 3: On the next two blank lines, enter your phone number and email address.

Alabama Incoming Transfer From Other Section 457 Plans To RSA-1 RSA-1 457 Step 4: On the next blank line, enter the name of your employer.

Alabama Incoming Transfer From Other Section 457 Plans To RSA-1 RSA-1 457 Step 5: On the next blank line, enter your date of birth.

Alabama Incoming Transfer From Other Section 457 Plans To RSA-1 RSA-1 457 Step 6: Indicate with a check mark whether you are a member of ERS/JRF, TRS or other.

Alabama Incoming Transfer From Other Section 457 Plans To RSA-1 RSA-1 457 Step 7: Part II concerns your previous 457 plan. Provide its name, the name of a contact person and their phone number, the plan's address, the account number with a trustee or record keeper, the qualified transfer amount and deferrals prior to 1997 not previously deferred for state of Alabama purposes. A trustee official or record keeper must sign and date this section.

Alabama Incoming Transfer From Other Section 457 Plans To RSA-1 RSA-1 457 Step 8: Part III contains payment transfers.

Alabama Incoming Transfer From Other Section 457 Plans To RSA-1 RSA-1 457 Step 9: In Part IV, enter the amount whose transfer you are authorizing on the blank line.

Alabama Incoming Transfer From Other Section 457 Plans To RSA-1 RSA-1 457 Step 10: Sign and date the page where indicated, then obtain the certification of a notary public.

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. 

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.

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.