service retirement application

832 12th Street, Suite 600 | Modesto, CA 95354 | (209) 525-6393 |[email protected]

Service Retirement Application

StanCERA Service Retirement Application Checklist

This checklist contains the forms and documents that you will need to provide before your application is considered complete. Once all these items have been submitted, in their entirety, your application for retirement will be processed. StanCERA can accept your retirement application no more than 60 days prior to your chosen date of retirement.

If you have any questions, please contact StanCERA at (209) 525-6393 or [email protected].

SUBMITTED FOR:

✓ ✓

You: Primary Beneficiary:

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IRE

D D

OC

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EN

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Copy of Certified Birth Certificate, if not on file

Copy of Driver’s License, Passport, or other form of legal identification

Copy of Marriage or Domestic Partnership Registration Certificate, if applicable

Social Security Benefit Estimate, if applicable

Copy of finalized divorce documents, if applicable

FO

RM

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NC

LU

DE

D W

ITH

AP

PL

ICA

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Completed Application for Service Retirement

Retiree Tax Withholding Election Form – W4-P

Authorization for Automatic Deposit

Other than Spouse or Domestic Partner Written Nomination of Beneficiary

$5,000 Death Benefit

Lump Sum Final Payment Upon Death Written Nomination of Beneficiary

Normal Retirement Age & Post Retirement Employment Questionnaire

Social Security Modification Option Acknowledgement

RESCO Information Request

Medical, Dental, & Vision Information Request

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mailto:[email protected]

StanCERA Service Retirement Application Information Packet

StanCERA recommends that you give as much notice as possible of your intended retirement date, preferably the entire sixty (60) days prior to retirement allowed by law, in the event there are discrepancies in your account.

There are a few items that you will need to provide to StanCERA and important factors to consider:

• Your date of retirement cannot be effective until the day after your last day on paidstatus with your employer (you cannot be paid by your employer for your date ofretirement);

• Your retirement effective date cannot be earlier than the date StanCERA receives yourapplication;

• You must notify your employer of your intent to retire and the effective date of yourretirement;

• Incremental age adjustment makes a difference in your benefit. For each quarter yearincrease in age the benefit will increase, up to a maximum age base on specific Tiers forboth General and Safety plans;

• The annual cost of living (COLA), as a retiree, is effective on April 1st of each year. Ifyou retire prior to April 1st, you will receive the appropriate cost of livingincrease/decrease provided to the retirees that year; and

• If you are a reciprocal member of another public agency, you are responsible to provideall necessary documents to the other system(s) and must use the same retirement datewith all systems.

REQUIRED DOCUMENTS TO BE SUBMITTED

The following documents are required in order to complete the application process. To avoid delay, you must provide photocopies of these documents to StanCERA with your completed application packet:

▪ Member’s Certified Birth Certificate (if not on file)▪ Member’s Driver’s License, Passport, or other form of legal identification▪ Certified Marriage or Domestic Partner Registration Certificate (if applicable)▪ Primary Beneficiary’s Certified Birth Certificate (if not on file)▪ Primary Beneficiary’s Driver’s License, Passport, or other form of legal identification▪ Social Security Benefit Estimate (if applicable)

If divorced during StanCERA Membership: ▪ Court endorsed Dissolution of Marriage/Partnership Judgment and Marital Settlement

Agreement, in their entirety (if not on file)▪ Domestic Relations Order, if applicable (if not on file)

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Your Service Retirement Application is not considered complete until all required documents have been received.

REQUIRED FORMS TO BE SUBMITTED:

The following forms are included in the application packet and must be completed and submitted:

▪ Original, completed StanCERA Service Retirement Application▪ Required Documents Listed▪ Written Nomination of Beneficiary – Other than Spouse or Domestic Partner (if applicable)▪ Retiree Tax Withholding Election Form – W4-P▪ $5,000 Death Benefit Form (if Applicable)▪ Written Nomination of Beneficiary – Final Lump Sum Payment Upon Death▪ Authorization Agreement for Automatic Deposit▪ Normal Retirement Age and Post Retirement Questionnaire▪ Social Security Modification Option Acknowledgement (if applicable)▪ RESCO/RESCO Insurance/Stanislaus County Risk Management Acknowledgement

FORMS EXPLAINED:

Retiree Tax Withholding Election Form – W4-P: Complete this form by checking at least one box each for Federal and California State tax withholding. A new tax withholding form may be completed as often as you wish throughout your retirement.

Authorization Agreement for Automatic Deposit: The completion of this form authorizes StanCERA to directly deposit your monthly benefits into the bank account of your choice on the first federal banking day of the month with a remittance advice mailed to you on a monthly basis. In order to verify bank routing andaccount numbers, the following is required:

▪ For Checking accounts, a voided check or bank documentation is required. Deposit slipsare not accepted.

▪ For Savings accounts, please include bank documentationAny new election or changes to automatic deposit will result in a physical check being issued for the first month, with automatic deposit beginning the next month.

Beneficiaries: For most members, the beneficiary is their qualified spouse or registered domestic partner. An eligible spouse or domestic partner is a person you have been married or registered to for at least one year prior to retiring. If a member marries or remarries after retirement, the new spouse or partner is not eligible for a continuing retirement benefit.

Written Nomination of Beneficiary – Other than Spouse or Domestic Partner If you designate your spouse/partner as your Primary Beneficiary and plan to choose the 60% Continuance Option, you will need to complete this form. In the unlikely event your spouse/partner pre-deceases you, any remaining contributions on account will be returned to this named beneficiary upon your death.

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$5,000 Death Benefit When a retiree passes away, a death benefit is paid to the designated beneficiary upon presentation of a photocopy of a valid, final, certified death certificate and a completed distribution packet to StanCERA. This is not a life insurance benefit and is taxable income to the designated beneficiary. You are permitted to change this beneficiary throughout your retirement. Exceptions to the burial allowance:

• In cases of reciprocity, if the retiree was last employed with another system, thebenefit will be paid by the last system.

• One death benefit is paid and applies to the original retiree.

Written Nomination of Beneficiary – Final Benefit Payment Upon Death When a retiree passes away, there may be a final payment to be made to the retiree’s estate. In order for this to be a smooth process, the retiree may name a beneficiary for this final lump sum payment.

Normal Retirement Age and Post Retirement Questionnaire: PEPRA and the IRS have established certain guidelines regarding the Normal Retirement Age and Post Retirement Employment. This questionnaire will assist members in determining if they qualify to return to part-time employment post retirement.

Social Security Modification Option: The Social Security Modification (Income Leveling) is a popular, yet complex option for members under age 62. Please read this form carefully prior to deciding if this is the right option for you. This form must be completed if you are under 62 and wish to take the Social Security Modification Option.

RESCO Information Request: Membership with Retired Employees of Stanislaus County Organization (RESCO), an independent organization, is voluntary. If you are taking advantage of optional insurance coverages offered through RESCO, membership is required. As a courtesy, StanCERA will forward your request for membership information as part of the retirement application process. Future inquiries are the responsibility of the retiree.

Medical, Dental, and Vision Information Request: Insurance coverage is an important part of the decision making when it comes to retiring. As a courtesy, StanCERA will forward your request for information on available plans to Pacific Group Agency and/or Stanislaus County as part of the retirement application process. However, please note that retirees are not limited to these individual plans. You are welcome to explore the options available through Covered California or with an individual broker.

Additional Information: The following is a list of additional materials included in your packet, which you may find helpful:

• Taxation of Retirement Benefits

• Employment after Retirement

• Cost of Living Adjustment

• PEPRA and IRS Decision Tree

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RETIREE PAYROLL:

StanCERA attempts to pay retirees within sixty (60) days after final payroll date. As a guide,the StanCERA Retirement Pay Schedule is included in the packet. Your monthly retirement allowance is paid on the first federal banking day of each month (not including weekends and holidays) for the month prior. The monthly retirement allowance check (or advice notice if utilizing direct deposit) is mailed to your location of choice: home, post office box, etc.

Depending on mail service, your check or advice notice may arrive anywhere from two (2) to seven (7) days after it is mailed. If you are away on vacation, the mail carrier may not deliver your check or advice notice. If your check is lost in the mail, StanCERA cannot request a replacement check for ten (10) business days. StanCERA strongly recommends signing up for automatic deposit with the financial institution of your choice.

It is your responsibility to keep your address current with StanCERA. Failure to maintain a current address will result in returned mail to StanCERA and may result in a suspension of your monthly retirement benefit. The U.S. Postal Service does not forward StanCERA correspondence.

All change forms need to be submitted to StanCERA by the 10th of each month to ensure the change will be effective by the following benefit payment.

WITHDRAWAL OF RETIREMENT APPLICATION:

A Service Retirement Application may be withdrawn, or the date of retirement changed, upon submitting a written request to StanCERA prior to the effective date of retirement. A withdrawal of application or change in retirement date will not serve to automatically reinstate your status as an employee. This is a separate issue between you and your employer, and the outcome will have no effect on your eligibility to receive retirement benefits. Members who withdraw their retirement application will be required to repeat the process and complete another packet when they are ready to begin the process in the future.

FINAL APPOINTMENT:

Upon receipt of your application, with the completed forms, all required documents, and your final payroll details, StanCERA will calculate your retirement benefit. You will be required to finalize your beneficiary designation and benefit option selection with StanCERA staff one final time after your date of retirement, before your first benefit payment is issued to choose your retirement option and to sign final documents.

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2021 StanCERA Retirement Pay Schedule

StanCERA uses the County’s payroll as a guideline when determining the first anticipated pay date of retirees. Effective retirement date is the day after last day of compensation by employer. StanCERA attempts to pay retirees 60 days from last active pay date.

Employment Dates: Final Active

Employee Pay Date

Anticipated First Retiree Pay Date

December 19, 2020 To January 1, 2021 January 13, 2021 March 1, 2021

January 2, 2021 To January 15, 2021 January 27, 2021 April 1, 2021

January 16, 2021 To January 29, 2021 February 10, 2021 April 1, 2021

January 30, 2021 To February 12, 2021 February 24, 2021 May 3, 2021

February 13, 2021 To February 26, 2021 March 10, 2021 May 3, 2021

February 27, 2021 To March 12, 2021 March 24, 2021 June 1, 2021

March 13, 2021 To March 26, 2021 April 7, 2021 June 1, 2021

March 27, 2021 To April 9, 2021 April 21, 2021 July 1, 2021

April 10, 2021 To April 23, 2021 May 5, 2021 July 1, 2021

April 24, 2021 To May 7, 2021 May 19, 2021 August 2, 2021

May 8, 2021 To May 21, 2021 June 2, 2021 August 2, 2021

May 22, 2021 To June 4, 2021 June 16, 2021 August 2, 2021

June 5, 2021 To June 18, 2021 June 30, 2021 September 1, 2021

June 19, 2021 To July 2, 2021 July 14, 2021 September 1, 2021

July 3, 2021 To July 16, 2021 July 28, 2021 October 1, 2021

July 17, 2021 To July 30, 2021 August 11, 2021 October 1, 2021

July 31, 2021 To August 13, 2021 August 25, 2021 November 1, 2021

August 14, 2021 To August 27, 2021 September 8, 2021 November 1, 2021

August 28, 2021 To September 10, 2021 September 22, 2021 December 1, 2021

September 11, 2021 To September 24, 2021 October 6, 2021 December 1, 2021

September 25, 2021 To October 8, 2021 October 20, 2021 December 1, 2021

October 9, 2021 To October 22, 2021 November 3, 2021 January 3, 2022

October 23, 2021 To November 5, 2021 November 17, 2021 January 3, 2022

November 6, 2021 To November 19, 2021 December 1, 2021 February 1, 2022

November 20, 2021 To December 3, 2021 December 15, 2021 February 1, 2022

December 4, 2021 To December 17, 2021 December 29, 2021 March 1, 2022

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2022 StanCERA Retirement Pay Schedule

StanCERA uses the County’s payroll as a guideline when determining the first anticipated pay date of retirees. Effective retirement date is the day after last day of compensation by employer. StanCERA attempts to pay retirees 60 days from last active pay date. First retirement benefit check cannot be issued all final pay and contributions are submitted to StanCERA by the employer and all required paperwork is completed and submitted to StanCERA by retiree.

Employment Dates: Final Active

Employee Pay Date Anticipated First Retiree Pay Date

December 18, 2021 To December 31, 2021 January 12, 2022 March 1, 2022

January 1, 2022 To January 14, 2022 January 26, 2022 March 1, 2022

January 15, 2022 To January 28, 2022 February 9, 2022 April 1, 2022

January 29, 2022 To February 11, 2022 February 23, 2022 April 1, 2022

February 12, 2022 To February 25, 2022 March 9, 2022 May 2, 2022

February 26, 2022 To March 11, 2022 March 23, 2022 May 2, 2022

March 12, 2022 To March 25, 2022 April 6, 2022 June 1, 2022

March 26, 2022 To April 8, 2022 April 20, 2022 June 1, 2022

April 8, 2022 To April 22, 2022 May 4, 2022 July 1, 2022

April 23, 2022 To May 6, 2022 May 18, 2022 July 1, 2022

May 7, 2022 To May 20, 2022 June 1, 2022 August 1, 2022

May 21, 2022 To June 3, 2022 June 15, 2022 August 1, 2022

June 4, 2022 To June 17, 2022 June 29, 2022 August 1, 2022

June 18, 2022 To July 1, 2022 July 13, 2022 September 1, 2022

July 2, 2022 To July 15, 2022 July 27, 2022 September 1, 2022

July 16, 2022 To July 29, 2022 August 10, 2022 October 3, 2022

July 30, 2022 To August 12, 2022 August 24, 2022 October 3, 2022

August 13, 2022 To August 26, 2022 September 7, 2022 November 1, 2022

August 27, 2022 To September 9, 2022 September 21, 2022 November 1, 2022

September 10, 2022 To September 23, 2022 October 5, 2022 December 1, 2022

September 24, 2022 To October 7, 2022 October 19, 2022 December 1, 2022

October 8, 2022 To October 21, 2022 November 2, 2022 January 2, 2023

October 22, 2022 To November 4, 2022 November 16, 2022 January 2, 2023

November 5, 2022 To November 18, 2022 November 30, 2022 January 2, 2023

November 19. 2022 To December 2, 2022 December 14, 2022 February 2, 2023

December 3, 2022 To December 16, 2022 December 28, 2022 February 2, 2023

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Service

Retirement

Application

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Application for Service Retirement Type or print in ink.

SECTION 1: RETIREE INFORMATION FIRST NAME: MI: LAST NAME: SEX: EMPLOYEE ID NUMBER:

MAILING ADDRESS: CITY: STATE: ZIP CODE:

HOME ADDRESS: CITY: STATE: ZIP CODE:

HOME PHONE: CELL PHONE: DATE OF BIRTH: SOCIAL SECURITY NUMBER:

E-MAIL ADDRESS: MOTHER’S MAIDEN NAME:

In accordance with provisions of the County Employees’ Retirement Act of 1937 and the Bylaws governing the

Association, I hereby make application for retirement from active/deferred service as: SECTION 2: EMPLOYMENT AND RETIREMENT INFORMATION LAST STANCERA EMPLOYER: DEPARTMENT: POSITION HELD:

LAST DATE OF EMPLOYMENT WITH STANCERA: PLANNED DATE OF RETIREMENT:

SECTION 3: RECIPROCITY, IF APPLICABLE

If applicable, all documents submitted to each retirement system must declare same retirement date.

Reciprocal Agency: Planned Date of Retirement:

Are you currently employed with reciprocal agency? Yes No

Do you have a higher salary with reciprocal agency? Yes No SECTION 4: SOCIAL SECURITY MODIFICATION OPTION, IF APPLICABLE (must be under age 62)

Requesting Social Security Modification Option. (GC §31810)? Yes No

If Yes, estimated Social Security amount at age 62: SECTION 5: MARRIAGE/DOMESTIC PARTNERSHIP

Are you legally married or have registered domestic partner? Yes No Date of marriage/registration:

Spouse/Partner’s name: Social Security number: Birthdate:

Were you divorced while employed? Yes No Date of Divorce: SECTION 6: DEPENDENT STATUS Do you have any minor children? Yes No CHILD’S NAME: SEX: DATE OF BIRTH: SOCIAL SECURITY NUMBER: RELATIONSHIP:

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SECTION 7: PRIMARY BENEFICIARY INFORMATION PRIMARY BENEFICIARY FIRST NAME: MI: LAST NAME: SEX: DATE OF BIRTH: SOCIAL SECURITY NUMBER:

BENEFIT PERCENT: MAILING ADDRESS: CITY: STATE: ZIP CODE:


HOME PHONE: CELL PHONE: E-MAIL ADDRESS: RELATIONSHIP:

IF MARRIED/REGISTERED DOMESTIC PARTNER STOP HERE. CONTINUE IF DESIGNATING MULTIPLE BENEFICIARIES. (Continuance options are available to one named beneficiary only.)

BENFICIARY #2 PRIMARY FIRST NAME: MI: LAST NAME: SEX: DATE OF BIRTH: SOCIAL SECURITY NUMBER:




BENFICIARY #3 PRIMARY FIRST NAME: MI: LAST NAME: SEX: DATE OF BIRTH: SOCIAL SECURITY NUMBER:




SECTION 8: REQUIRED SIGNATURES Pursuant to StanCERA Bylaw Article 5.1, application for service retirement shall be deemed complete when all required documents and forms have been received. Applications shall not be accepted more than 60 days prior to date of retirement.

Applicant Signature: Printed Name: Date:

Spouse/Partner Signature: Printed Name: Date:

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Retiree Tax Withholding Election Form – W4-P Type or print in ink.

RETIREE INFORMATIONFIRST NAME: MI: LAST NAME: DATE OF BIRTH: SOCIAL SECURITY NUMBER:

NEW ADDRESS? YES NO



HOME PHONE: CELL PHONE: EMAIL ADDRESS:

FEDERAL WITHHOLDING ELECTION

OPTION 1: I want federal income tax withheld from my monthly retirement benefit as follows:

Marital Status: Single Married

Number of withholding allowances (enter “0” of zero):

I want the following amount withheld in addition to the federal tax table: $

OPTION 2: I do not want federal income tax withheld from my monthly retirement benefit.

(Not available to U.S. Citizens living in a foreign country) CALIFORNIA STATE WITHHOLDING ELECTION

OPTION 1: I want California State income tax withheld from my monthly retirement benefit as follows:

Marital Status: Single Married

Number of withholding allowances (enter “0” of zero):

I want the following amount withheld in addition to the California tax table: $

OPTION 2: I do not want California State tax withheld from my monthly retirement benefit.

OPTION 3: I want the designated flat amount withheld from each monthly retirement benefit. $

AUTHORIZATION

Any prior Federal or California State withholding form on file with StanCERA is hereby revoked. I further understand that any request received by StanCERA on or before the 10th of the month, will become effective the next payroll process.

Retiree Signature: Printed Name: Date:

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Authorization Agreement for Automatic Deposit Type or print in ink.

SECTION 1: PAYEE INFORMATION

FIRST NAME: MI: LAST NAME: DATE OF BIRTH: SOCIAL SECURITY NUMBER:

NEW ADDRESS? YES NO




SECTION 2: FINANCIAL INSTITUTION INFORMATION

NAME OF FINANCIAL INSTITUTION: PHONE NUMBER:

ADDRESS: CITY: STATE: ZIP CODE:

ROUTING NUMBER: ACCOUNT NUMBER:

ACCOUNT INFORMATION:

TYPE OF ACCOUNT:

Checking Account: Attach voided check or bank documentation with routing and account number (deposit slips not accepted).

Savings Account: Attach bank documentation with routing and account number.

IMPORTANT PAYROLL INFORMATION:All payroll changes must be submitted prior to the 10th of every month, to become effective the followingmonth. Any new election or changes to automatic deposit will result in a physical check being issued for thefirst month, with automatic deposit beginning the next month.

SECTION 3: AUTHORIZATION

I hereby authorized the Stanislaus County Employees’ Retirement Association to initiate, if necessary, debit entries and adjustments for any credit entries in error to my account, and the depository named above to credit and/or debit the same to such account. The U.S. Postal Service does not forward StanCERA correspondence. Failure to maintain a current U.S. postal address or, mail returned to StanCERA, may result in a suspension of my direct deposit.

Retiree Signature: Printed Name: Date:

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Type or print in ink.

SECTION 1: RETIREE INFORMATION


NEW ADDRESS? YES NO




SECTION 2: BENEFICIARY INFORMATION

PRIMARY BENEFICIARY





BENFICIARY #2 PRIMARY CONTINGENT










Designation of Beneficiary Other than Spouse or Domestic Partner(To be completed if choosing 60% continuance option)

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RETIREE INFORMATION – PAGE 2FIRST NAME: MI: LAST NAME: DATE OF BIRTH: SOCIAL SECURITY NUMBER:











SECTION 3: REQUIRED SIGNATURES

I hereby nominate the above-named beneficiary to receive a return of any member contributions, still on deposit, in the event of my death and the death of my spouse/domestic partner at the time of my death and upon receipt of aphotocopy of my final certified death certificate. I also acknowledge that any amounts owed to Stanislaus County Employees’ Retirement Association upon my death, which are not recoverable will be deducted from this final benefit payment.

This revokes any and all previous beneficiaries nominated for this benefit.

Date:Printed Name:Applicant Signature:

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NEW ADDRESS? YES NO





PRIMARY BENEFICIARY















Written Nomination of Beneficiary $5,000 Retiree Death Benefit

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I hereby nominate the above-named beneficiary to receive a $5,000 death benefit at the time of my death and uponreceipt of a photocopy of my final certified death certificate.



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NEW ADDRESS? YES NO





PRIMARY BENEFICIARY















Written Nomination of Beneficiary Final Benefit Payment Upon Death

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I hereby nominate the above-named beneficiary to receive the final benefit payment payable to me, if any, at the time ofmy death and upon receipt of a photocopy of my final certified death certificate. I also acknowledge that any amounts owed to Stanislaus County Employees’ Retirement Association upon my death, which are not recoverable will be deducted from this final benefit payment.



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Normal Retirement Age and Post Retirement Employment Questionnaire General Members

I, , hereby acknowledge that StanCERA staff has provided me with

Items “A” and “B” listed below and reviewed the requirements for being rehired after my retirement.

I understand that if I return to employment with a StanCERA covered employer, at a later date, the same requirements and limits, stated below, remain in order as not to jeopardize my StanCERA benefits.

A. PEPRA and IRS Decision Tree for Rehiring Retired General Members

1.Are you planning to return to work for a StanCERA Covered Employer?If No, go to Item “B”

□ Yes □ No

2. Are you age 62 or older? □ Yes □ No

3. Have you been offered a position to return to work by a hiring authority? □ Yes □ No

4. Is this appointment an emergency as defined by GC §7522.56? □ Yes □ No

5.Has the emergency appointment been approved by the Board ofSupervisors?

□ Yes □ No

B. Employment After Retirement Pamphlet

• Required to sit-out 180 days post-retirement prior to reemployment unless Boardof Supervisors approves exception due to critical staffing need in a non-consentitem (GC §7522.56);

• Retires under the age of 62 required to sit-out 60 days post-retirement prior toreemployment. This time runs concurrently with PEPRA requirements (IRSrequires Bona Fide separation from service);

• Post-retirement employment with a StanCERA employer limits you to work nomore than 960 hours or 120 days, which ever is greater, per calendar year (GC§31680.3(a));

• Ineligible for employment if the retiree has accepted unemployment during thelast 12 months based upon post-retirement employment with any StanCERAemployer (GC §31680.3(b));

• Employment with an employer who does not use StanCERA for retirementbenefit administration, whether public or private, will not affect your StanCERAretirement benefits.

Member Signature: Printed Name: Date:

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Normal Retirement Age and Post Retirement Employment Questionnaire Safety Members

I, , hereby acknowledge that StanCERA staff has provided me with

Items “A” and “B” listed below and reviewed the requirements for being rehired after my retirement.

I understand that if I return to employment with a StanCERA covered employer, at a later date, the same requirements and limits, stated below, remain in order as not to jeopardize my StanCERA benefits.

A. PEPRA and IRS Decision Tree for Rehiring Retired General Members

1.Are you planning to return to work for a StanCERA Covered Employer?If No, go to Item “B”

□ Yes □ No

2. Are you age 50 or older? □ Yes □ No

3. Have you been offered a position to return to work by a hiring authority? □ Yes □ No

4. Is this appointment an emergency as defined by GC §7522.56? □ Yes □ No

5.Has the emergency appointment been approved by the Board ofSupervisors?

□ Yes □ No

B. Employment After Retirement Pamphlet

• No sit-out period for Safety Members, at age 50 or older, if returning to (GC§7522.56);

• Public safety retirees under age 50 are required to sit out 60 days post-retirementprior to reemployment (IRS requires Bona Fide separation from service);

• Post-retirement employment with a StanCERA employer limits you to work nomore than 960 hours or 120 days, which ever is greater, per calendar year (GC§31680.3(a));

• Ineligible for employment if the retiree has accepted unemployment during thelast 12 months based upon post-retirement employment with any StanCERAemployer (GC §31680.3(b));

• Employment with an employer who does not use StanCERA for retirementbenefit administration, whether public or private, will not affect your StanCERAretirement benefits.


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Social Security Modification Option Acknowledgment Form StanCERA members electing the Social Security Modification (Income Leveling) Option are required to acknowledge the information in this document. Choosing the Social Security Modification is an irrevocable decision made at the time of application of StanCERA Retirement Benefits.

If you qualify for Social Security Benefits, you may elect to choose the Social Security Modification (Income Leveling) Option and receive a monthly retirement allowance with an income leveling approach rather than the fixed-for-life fashion of the original plan design. With this election, a member receives an increased monthly allowance before age 62 from StanCERA, which is based on the Social Security benefit estimate at age 62. The StanCERA benefit is reduced at age 62 at which time the member would be responsible to apply for benefits directly with the Social Security Administration. It is recommended that members apply for their Social Security benefits prior to their reduction of their StanCERA benefit.

StanCERA’s administration of the Social Security Modification (Income Leveling) Option is not subject to any changes to the laws governing Social Security benefits. In the event Social Security modifies the early retirement age from age 62, StanCERA will not modify the original payment agreement and would still be required to reduce the StanCERA benefit at age 62.

This Option does not alter monthly continuance payments to the designated beneficiary. The beneficiary’s continuance is based on the original payment option. The Social Security Modification (Income Leveling) Option is not available to members who receive a disability retirement from StanCERA.

Understanding your Social Security Statement

Social Security Statements provide estimated benefit amounts using average earnings over a working lifetime. Social Security assumes one will continue to work until age 62 (earliest eligible age to apply for benefits), full retirement age (age 65 – 67 depending on birth year), or age 70. Social Security is unable to provide an actual benefit amount until time of application.

StanCERA members who choose to retire prior to age 62 and elect the Social Security Modification (Income Leveling) payment option, are required to submit an accurate Social Security estimate of eligible benefits at 62 at time of application of StanCERA retirement. Members are encouraged to use the Social Security Benefit Calculator, located on the Social Security Administration’s website, to obtain immediate and personalized benefit estimate. This Benefit Calculator provides an optional stop-working age, which would imply no future payments into the Social Security System from the time of retirement until age 62. This option allows a more realistic estimate of the Social Security benefit. A link to this calculator may be found by visiting StanCERA’s website at: www.stancera.org.

If a member is eligible to receive a pension from employment in which Social Security taxes were not paid and you also qualify for a Social Security retirement benefit, the Social Security benefit may be reduced by the Windfall Elimination Provision (WEP). The amount of the reduction, if any, depends on the earnings and number of years in jobs in which Social Security taxes were paid. To estimate WEP’s effect on future Social Security benefits, information may be found on their website.

By signing below, you are declaring under penalty of perjury, that an accurate estimate of eligible Social Security Benefits at age 62 has been provided, which is to be used for StanCERA’s Social Security Modification (Income Leveling) Payment Option. It is understood that this option is irrevocable upon activation of StanCERA Retirement Benefits.


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http://www.stancera.org/


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RESCO

(RETIRED EMPLOYEES OF STANISLAUS COUNTY ORGANIZATION)

RESCO serves the retired employees of Stanislaus County and Special Districts. It is an independent

organization of retirees and is devoted entirely to the needs of the retirees. RESCO is the ONLY OFFICIAL

ORGANIZATION that represents all retired employees of Stanislaus County and its Special Districts. Anyone

who is presently receiving or anticipating a monthly retirement allowance from the Stanislaus County

Employees’ Retirement Association (StanCERA) is eligible to become a RESCO member.

RESCO P.O. Box 1646

Modesto, CA 95353

(209) 521- 1666

www.RescoToday.org | [email protected]

My signature below is an acknowledgment that StanCERA has informed me that due to confidentiality laws,

StanCERA will not automatically transmit my contact information to RESCO, unless I authorize StanCERA to

release my printed information. By marking "Yes" below, I am authorizing StanCERA to release my

information to RESCO, otherwise, it will be my responsibility to contact RESCO directly if I am interested in its

services.

I hereby authorize StanCERA to provide my initial contact information to RESCO upon retirement.

Yes No

MEMBER NAME:



MEMBER SIGNATURE: Date:

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INFORMATION REGARDING MEDICAL, DENTAL & VISION COVERAGE

Last Employer:

City of Ceres East Side Mosquito Abatement District Hills Ferry Cemetery District Keyes Community Services District

Salida Sanitary District Stanislaus Council of Governments Stanislaus County Superior Court

Medical Coverage:

I am under 65 years old Yes No

My spouse is under 65 years old Yes No

If yes, Stanislaus County Risk Management may have medical plans available.

Would you like information regarding these medical plans? Yes No

Contact Information: Stanislaus County Risk Management1010 Tenth Street, Suite 5900Modesto, CA 95354(209) 525-5715 | [email protected]

I am over 65 years old Yes No

My spouse is over 65 years old Yes No

If yes, RESCO Insurance may have medical plans available.

Would you like information regarding these medical plans? Yes No

Contact Information: RESCO Insurance administered by Pacific Group Agencies25876 The Old Road #11Santa Clarita, CA 91381(800) 511-9065 | [email protected]

Dental and Vision Coverage:

Dental and vision coverage is available for all retirees through RESCO Insurance regardless of age.

Would you like information regarding dental and vision plans? Yes NoContact Information:

RETIREE NAME: DATE OF BIRTH: DATE OF RETIREMENT: DATE OF TERMINATION:




MARITAL STATUS: SPOUSES NAME: DATE OF BIRTH:

Signing below is an acknowledgment that StanCERA has informed me, that due to contact changes and confidentiality laws, StanCERA will not automatically transmit my contact information to Stanislaus County Risk Management, RESCO Insurance, or both unless I authorize StanCERA to release my information by marking “yes” and signing above.


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Applicant

Information

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Taxation of Your Retirement Benefit

This document provides a general summary of how StanCERA withholds payments and reports payments to the Internal Revenue Service (IRS) and the California Franchise Tax Board (FTB). These are general provisions and may not apply to all benefits. Individuals should consult with an independent tax professional to ensure proper tax filings and the correct payment of federal and state taxes.

Retiree Payroll Federal and State Income Tax Withholding Information

All StanCERA retirees who receive a pension are required to select one of three tax withholding options:

• federal and/or state income taxes withheld according to tax tables based onmarital status and number of allowances;

• specific dollar amount withheld for federal and/or state income taxes; or

• no federal and/or state income taxes withheld (exempt).

For those who elect to have income withheld based on tax tables, monies will not be withheld unless the gross monthly retirement allowance exceeds the minimum amount listed on the tax table for your filing status. If a filing status is not chosen, StanCERA will default both State and Federal elections to Married/3 until a change request is received from retiree.

Penalties may be assessed by the IRS and/or the FTB if enough tax dollars are not withheld, or the correct amount of tax is not paid. Contact an independent tax consultant for individualized information.

California State Tax Information for Non-Residents

Those residing outside the State of California, will not have California state taxes withheld unless a withholding is elected. StanCERA is required to report all benefits paid to the California Franchise Tax Board regardless of residency.

1099-R Tax Statement

Annually StanCERA provides a 1099-R containing benefits paid in the prior calendar year. This documentation provides information such as gross amount received, taxable amount received, Federal income tax withheld, State tax withheld, etc.

Service-Connected Disability Retirement

Service-connected disability retirement benefits received from StanCERA, all or a portion of the benefits, may be nontaxable. The Internal Revenue Code provides special tax treatment if a retirement is due to a service-connected disability.

If a service-connected disability pension is no more than half the final average salary as determined by StanCERA, the entire amount is generally tax free similar to worker’s compensation. If a service-connected disability pension is more than half of the final average salary, then generally the portion that equals half of the final average salary is tax free and the remainder is taxable. Any Cost of Living Adjustment (COLA) associated with a service-connected disability pension is taxable or untaxable accordingly.

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Calculation of the Taxable Amount of Your Benefit

In general, the total amount received as a retirement benefit from StanCERA, except as described above as a service-connected disability benefit, is taxable. However, if contributions were made from post-tax funds, then these amounts may be recovered tax free. The amount received annually, from post-tax contributions, are reported on the 1099-R.

StanCERA staff does not provide tax advice nor will answer personal tax questions. Any questions regarding Federal income taxes should be directed to the Internal Revenue Service, questions regarding California State taxes should be directed to the Franchise Tax Board, or a personal tax advisor.

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Employment After Retirement

On September 12, 2012, the Governor approved the Public Employees’ Pension Reform Act (PEPRA). This legislation effects retired StanCERA members working part-time.

A retiree may work for a StanCERA employer as a temporary (part-time) employee, without reinstatement, if requirements meet the criteria of PEPRA.

In general, retirees receiving a benefit from StanCERA and not already working part-time for a StanCERA employer on or before December 31, 2012, will not be allowed to return to work for a StanCERA employer after December 31, 2012; however, there are some exceptions to this rule:

• If 180 days have passed since the retirement effective date and the employer certifies toStanCERA that the retiree’s skills are needed to perform work of a limited duration or toprevent an emergency stoppage of public business; or

• If 180 days have not passed since the retirement effective date and the governing bodyof the employer declares, in a public meeting, that the retiree’s skills are necessary to filla critically needed position; and

• The retiree must not have received unemployment insurance compensation within 12months prior to the expected date of employment.

*Public safety members are exempt from the “less than 180-day rule”

If the above criteria is met, then a retiree may return to work, not exceeding 960 hours per calendar year.

Items of Note:

o Retirees do not accrue service credit or acquire retirement rights for temporary (part-time)employment.

o It is the responsibility of the retiree and the employer to ensure employment remains incompliance, as not to jeopardize any StanCERA retirement benefits.

o Working for an employer whose retirement benefits are not administered by StanCERA,whether public or private, will not have an affect on any StanCERA retirement benefits.

If any questions remain contact StanCERA staff at (209) 525-6393 or [email protected].

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Retiree Cost of Living Adjustment (COLA)

The retiree cost-of-living adjustment (COLA) is based on the average annual change in the U.S. Department of Labor, Bureau of Labor Statistics Consumer Price Index (CPI) for All Urban Consumers for the San Francisco Bay Area. According to the County Employees Retirement Law of 1937, the Retirement Board must determine the appropriate COLA for StanCERA retirement benefits and implement that COLA effective April 1 each year.

The maximum COLA benefit that can be granted in any given year is a 3% increase or decrease. Any excess will be tracked on a retirement year basis, creating a COLA bank. If the change in the cost-of-living is less than the maximum adjustment, the COLA bank is then utilized to increase the COLA granted up to the maximum of 3% in those years.

Should a negative COLA adjustment become necessary, the accumulated COLA benefit amount would be reduced by the negative adjustment percentage. If the retiree has banked COLA, the maximum percentage increase allowable would be applied to offset the negative adjustment up to the 3% maximum allowable.

It is important to understand that a cost-of-living decrease cannot reduce a benefit allowance to be less than the original amount granted at the time of retirement.

The COLA is reflected annually on the May retirement check (payment of April benefits). Members who have a retirement date on or before March 31 are eligible for that year’s COLA. Members who retire after March 31 will be eligible to receive a COLA in future years, if applicable.

Tier 3 members are not eligible for cost of living adjustments.

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NO

PEPRA and IRS Decision Tree for Rehiring General Members

• A retiree may not return to work, under any circumstance, if he/she has received unemployment insurance in the last 12 months with any StanCERA

employer.

• An emergency is defined in Government Code §7522.56 as (1) an event that would stop public business or (2) the appointment necessary to fill a

critically needed position.

Is retiree age 62 or older?

Is this appointment an emergency?

Retiree may return with Governing Board approval or if 180 days has passed

since retirement.

Retiree may accept appointment 180 days

after retirement.


Retiree may return with Governing Board Approval

Prior to retirement, was there a pre-determined

arrangement to return to work?

Retiree may not return until age 62.


after retirement.

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NO

PEPRA and IRS Decision Tree for Rehiring Safety Members

• A retiree may not return to work, under any circumstance, if he/she has received unemployment insurance in the last 12 months with any StanCERA

employer.

• An emergency is defined in Government Code §7522.56 as (1) an event that would stop public business or (2) the appointment necessary to fill a

critically needed position.

Is retiree age 50 or older?

Is retiree returning to a Safety Position?

Retiree may return to work immediately.



after retirement.


after retirement.


Retiree may return with Governing Board

Approval

Prior to retirement, was there a pre-determined

arrangement to return to work?

Retiree may not return until age 50.

Is retiree returning to a Safety Position?


after retirement.


after retirement.

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