Fillable A Guide To CalPERS Reinstatement From Retirement (PUB 37) (California)

Fill Online, Printable, Fillable, Blank A Guide To CalPERS Reinstatement From Retirement (PUB 37) (California) Form

Use Fill to complete blank online CALIFORNIA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

A Guide To CalPERS Reinstatement From Retirement (PUB 37) (California)

On average this form takes 16 minutes to complete

The A Guide To CalPERS Reinstatement From Retirement (PUB 37) (California) form is 50 pages long and contains:

  • 0 signatures
  • 3 check-boxes
  • 64 other fields

Country of origin: US
File type: PDF

BROWSE CALIFORNIA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
A Guide to CalPERS
Reinstatement From Retirement
This page intentionally left blank to facilitate double-sided printing.
www.calpers.ca.gov
TABLE OF CONTENTS
What Is Reinstatement? ...................................3
Things to Consider Before You Reinstate ...................4
PEPRA vs. Classic Membership
............................4
Final Compensation and Compensation Limits
.................5
Health Benefits
........................................5
Cost-of-Living Adjustments
...............................6
Reciprocal Benefits
.....................................6
Golden Handshake
.....................................6
Sick Leave Service Credit
.................................7
Community Property
...................................8
How to Estimate Your Future Service Retirement Benefit .....9
Less Than One Year of Service Credit Earned
................. 10
Sample Calculation
—
Classic/PEPRA ....................... 11
At Least One Year of Service Credit Earned
................... 11
Sample Calculation
—
Classic/PEPRA ....................... 12
Sample Calculation
—
Classic/Classic ....................... 13
How to Reinstate From Service Retirement ................ 14
Notify the Right People
................................. 14
Get a Firm Start or Hire Date
............................ 14
Submit Your Reinstatement From Service Retirement
Application Form
................................... 14
How to Reinstate From Disability or
Industrial Disability Retirement ..........................15
Obtain Approval From CalPERS
.......................... 15
Submit Your Reinstatement From Disability/Industrial
Disability Retirement Application Form
................... 15
Submit Your Required Documentation
...................... 15
Submit Your Medical Clearance Report
..................... 16
Mandatory Reinstatement Rights
—
State or CSU Retirees ........ 17
Industrial Disability to Miscellaneous Position
................ 18
Become a More Informed Member ........................ 19
CalPERS Website
..................................... 19
myCalPERS
......................................... 19
CalPERS Education Center
.............................. 19
Experience CalPERS Through Social Media
.................. 19
Reach Us by Phone
.................................... 19
Visit Your Nearest CalPERS Regional Office
.................. 20
Privacy Notice .......................................... 21
Forms ..................................................23
Reinstatement From Service Retirement Application Form
........ 23
Reinstatement From Disability/Industrial Disability
Retirement Application Form
........................... 25
Authorization to Disclose Protected Health Information Form
..... 27
Physical Requirements of Position/Occupational Title Form
....... 29
888 CalPERS (or 888-225-7377)
3www.calpers.ca.gov
WHAT IS REINSTATEMENT?
If you retired from CalPERS and are considering returning to work for a
CalPERS-covered employer, there are rules and restrictions you need to
know about before accepting any position. As a CalPERS retiree, you may
either work as a retired annuitant or reinstate to active service.
Work as a Retired Annuitant or Reinstate to Active Service
Retired annuitants are retirees
who work for a CalPERS
employer and continue to
receive a retirement allowance
from CalPERS. Employment is
limited to 960 hours per year and
is not a permanent position.
Reinstatement means you come
out of retirement to work for a
CalPERS employer as a permanent
employee. This is any permanent
position, even if it’s part time.
You receive regular paychecks,
earn service credit, and make
contributions to CalPERS, just
as you did before retiring. Your
retirement checks stop until
you decide to retire again.
This publication provides information about voluntarily reinstating to active
employment. For information on working as a retired annuitant, please refer
to A Guide to CalPERS Employment After Retirement (PUB 33). You can
find this publication on our website at www.calpers.ca.gov.
There are laws CalPERS
retirees must follow when
returning to CalPERS-
covered employment, but
retirees can work under
another California public
retirement system with
no restrictions.
Voluntary reinstatement
is your choice. Mandatory
reinstatement can happen
when you violate the
rules for working after
retirement.
4 888 CalPERS (or 888-225-7377)
THINGS TO CONSIDER BEFORE YOU REINSTATE
PEPRA vs. Classic Membership
The California Public Employees’ Pension Reform Act of 2013 (PEPRA)
changed the way CalPERS retirement benefits are applied. Before you come
out of retirement, it’s important to understand whether your new service will
be subject to the rules of PEPRA and how PEPRA may affect your future
retirement benefit.
If you are not subject to PEPRA, you are considered a “classic” member and
the time you work as a classic member is typically subject to the laws in place
before PEPRA. However, it’s possible to be both a PEPRA and classic member.
If you currently are or were a member of another California public retirement
system and you want to know whether you will be a PEPRA or classic member
when you reinstate, contact us for more information.
If you had some or all classic membership when you retired, determining
whether you will be a PEPRA or classic member when you reinstate depends
on which employer you reinstate to and how long you have been separated—
not retired—from CalPERS employment. Refer to the chart below.
If you separated
from your last
employer as… Then you reinstate with… You will be a…
a classic
member only
• any employer, and
• have been separated for less
than six months
classic member
• any employer you previously
worked for,* and
• have been separated for more
than six months
classic member
• an employer you have never
worked for, and
• have been separated for more
than six months
PEPRA member
a PEPRA
member only
• any employer regardless of how
long you have been separated
PEPRA member
* All State of California departments, including California State Universities (CSU), are
considered the same state employer. All school county offices and districts are considered
the same school employer. Public agencies are considered different employers.
5www.calpers.ca.gov
If you separated
from your last
employer as… Then you reinstate with… You will be a…
both a classic
and a PEPRA
member
• any employer you previously
worked for as a classic member
classic member
• any employer you previously
worked for as a PEPRA member
PEPRA member
• any employer you have never
worked for, and
• have been separated for more
than six months
PEPRA member
Final Compensation and Compensation Limits
Final compensation is your highest average annual compensation during any
consecutive 12- or 36-month period of employment. All PEPRA members
have a 36-month final compensation period. PEPRA salaries only apply to
PEPRA service, and classic salaries only apply to classic service (California
Code of Regulations section 579.24).
The amount we can use in your retirement calculation may be limited by
PEPRA, Internal Revenue Code section 401(a)(17), or both. These limits do
not limit the salary you can receive, but rather limit the amount we can use to
calculate your retirement benefit. The limits are updated at the beginning of
each year. You can read more about these compensation limits in your member
benefit publication or visit our website at www.calpers.ca.gov.
Health Benefits
If you currently have CalPERS retiree health coverage, you will need to
enroll in a basic health plan as an active employee with your new employer
or get other health coverage. You may be eligible to resume your retiree
health coverage from the employer you first retired with if you meet all
of the following requirements:
• You are eligible for CalPERS retiree health coverage before you reinstate.
• Your first employer’s health premium contribution amount is higher than
the new employer.
• You re-retire within 120 days of separating from employment with the
new employer.
• You notify us in writing within 60 days of your new retirement date or
during Open Enrollment that you want to receive health benefits from
the employer you first retired from.
6 888 CalPERS (or 888-225-7377)
If you are not currently eligible for CalPERS retiree health benefits, ask
your new employer if they contract for CalPERS health benefits. You may
be eligible for CalPERS retiree health benefits when you re-retire.
Cost-of-Living Adjustments
Cost-of living adjustments (COLA) are typically paid beginning the second
calendar year after you retire and compound annually. The longer you’ve
been retired, the higher the compounded factor. When you reinstate and
then re-retire, your COLA is paid the second calendar year after your
new retirement date and is based on your new retirement benefit, but you
do not retain the compounded factor. This could cause your future benefit
to be lower than what it is now.
Example: You retired in 2010, and your employer’s contracted COLA
percentage is 2 percent. You reinstate in 2018, and your current COLA
factor is 12.41 percent. If you retire again in 2020, you become eligible
for your first COLA in 2022. The COLA factor would be the lower of
either the rate of inflation or 2 percent.
Reciprocal Benefits
If you retired concurrently (on the same day) with another California public
retirement system and we used the other system’s salaries to calculate your
CalPERS retirement benefit, reinstatement breaks the concurrent retirement.
This means your CalPERS retirement will be based on your CalPERS salaries
when you re-retire.
Golden Handshake
If you received additional service credit as an incentive to retire, this benefit
is lost when you reinstate and will not be included in your future retirement
benefit. This could cause your future retirement benefit to be lower than
it is now.
7www.calpers.ca.gov
Sick Leave Service Credit
If unused sick leave days are included in your current retirement calculation,
your sick leave may be restored to your active employee account depending
on what type of agency you retired from and how long you’ve been retired.
See the following chart for details.
If you retired
from…
And you return
to work with… Then your sick leave…
the State of
California
the State of California
within six months of your
initial retirement date
will be restored to your
active employee balance
• a public agency,
• school employer, or
• the State of California
more than six months
from your initial
retirement date
stays in your retirement
account
a school
employer or
a public agency
• a school employer,
• public agency, or
• the State of California
stays in your retirement
account*
* If your school or public agency employer will be restoring your unused sick leave
to your active employee account, they must notify us immediately upon your return
so your sick leave can be removed from your retirement account. Otherwise, it stays
credited to your retirement account.
If you have unused sick leave with your new employer when you’re ready to
re-retire, this sick leave will be used in your new retirement calculation if the
employer contracts for this benefit and you retire within 120 days of separating
from employment. Any sick leave credit that remained in your retirement
account will also be included in your new benefit.
8 888 CalPERS (or 888-225-7377)
Community Property
If you resolved a community property claim from your first retirement using
a time rule division, your nonmember spouse’s benefit will stop when you
reinstate to active employment. Depending on the type of model order used
to divide your benefits, you may need to submit a new court order before you
retire again. Refer to the chart below.
If your benefits were divided using… Then…
Model Order B
(Time Rule Future Division)
• we will use the existing court
order on file, or
• you and your nonmember spouse
can agree to use a different
method of division before you
re-retire.
Model Order C
(Time Rule Post-Retirement Split)
• the existing court order on file
will no longer be valid, and a new
court order will be required before
you re-retire.
Note: Refer to A Guide to CalPERS Community Property (PUB 38A) for more information.
Important!
Your future benefit could be lower than your current retirement
benefit. Some reasons that can cause this are:
• Your and your beneficiary’s ages are different when you retire again.
• You may have received a temporary annuity payment on your
first retirement.
• You may have changed your retirement type. For example,
you originally retired on a service retirement but re-retire on
a disability retirement.
• You do not retain your compounded COLA factor when
COLA becomes payable again. This could cause your future
retirement benefit to be lower than it was when you returned
to active membership.
9www.calpers.ca.gov
HOW TO ESTIMATE YOUR FUTURE SERVICE
RETIREMENT BENEFIT
Often the decision to come out of retirement depends on whether your
future retirement benefit will increase and by how much.
Your future retirement benefit will depend on:
• How much additional service credit you earn
• PEPRA vs. classic membership
• How long you were initially retired
• Your age at your next retirement
We have provided sample calculations to help you figure out your potential
future retirement benefit. Before we continue, let’s go over key points of the
basic retirement calculation.
Unmodified Allowance
The Unmodified Allowance is the highest possible benefit and is based
on three things:
• Years of service credit
• Benefit factor
• Final compensation
We calculate an Unmodified Allowance for each employer you work for and
then add them to get your total Unmodified Allowance.
Service Credit
Service credit is earned on a fiscal year basis, which is July 1 through June 30.
If you are paid on a monthly basis, 10 months of full-time employment will
equal one year. You cannot earn more than one year of service credit in one
fiscal year. If you work less than eight hours per day, it will take you longer
to earn a year of service credit.
Benefit Factor
Your benefit factor, also known as “age factor,” is the percentage of pay you
receive for each year of service credit earned. Your benefit factor is determined
by your retirement formula and age at retirement. Benefit factor charts are
located in our CalPERS member benefit publications at www.calpers.ca.gov.
Final Compensation
Your final compensation is your highest average annual compensation
during any consecutive 12- or 36-month period of employment. We use
your full-time pay rate, not your earnings. If you work part time or are
paid hourly, we convert your pay rate to a monthly equivalent.
Pay rate excludes any
additional pay you receive
like longevity pay, uniform
allowance, etc.
=
X X
Service
Credit
Benefit
Factor
Final
Compensation
Unmodified
Allowance
10 888 CalPERS (or 888-225-7377)
Classic to Classic
If your new employer’s salaries are higher, but you don’t work the entire
final compensation period, we bridge your new and old salaries to come
up with the additional months needed to complete the consecutive
12- or 36-month period.
Example: If your employer has a 12-month final compensation period
and you work six months during your reinstatement period, we will use
these six months of salaries and take your last six months of salaries prior
to your first retirement to come up with 12 months.
Classic to PEPRA
If you work less than 36 months, we will extend your first PEPRA pay rate
backward for the amount of months needed to come up with the consecutive
36 months. We will use classic salaries for classic service and PEPRA salaries
for PEPRA service, which means you will have more than one final
compensation amount.
Example: If you reinstated as a PEPRA member and you only worked for
24 months out of the 36-month final compensation period, we will extend
your first PEPRA pay rate backward to come up with the number of months
needed to complete the 36 consecutive months of final compensation. Your
classic salaries cannot be combined with your PEPRA salaries.
Less Than One Year of Service Credit Earned
If you earn less than one year of service credit after you reinstate, we calculate
an Unmodified Allowance based on your new service and then add it to your
original Unmodified Allowance along with any cost-of-living increase to get
your new Unmodified Allowance.
=
+
Original
Unmodified
Allowance
Reinstatement
Unmodified
Allowance
New
Unmodified
Allowance
Your actual allowance
will depend on whether
you choose to name a
beneficiary to receive all
or some of your benefits
upon your death. For
simplicity, we will use the
Unmodified Allowance
for the first and second
retirement benefit.
11www.calpers.ca.gov
Sample Calculation
—
Classic/PEPRA
Dan retired as a classic member and reinstated as a PEPRA member.
He earns five months of service credit and then re-retires.
New retirement formula: PEPRA 2% at 62
PEPRA salaries: $5,500
Age at second retirement: 65.00 years
Original Unmodified Allowance: $4,000
Dan’s new benefit is $4,000 + $63.25 = $4,063.25*
* The data used in this example is hypothetical and is not based on any real-life person(s).
Final compensation may be affected by allowable special compensation, service
coordinated with Social Security, and/or applicable compensation caps.
At Least One Year of Service Credit Earned
If you earn one year or more of service credit after you reinstate, we use your
age at the second retirement to calculate an Unmodified Allowance on your
new service. Then we recalculate your original Unmodified Allowance using
a determined age and add them together to come up with your new
Unmodified Allowance.
=
+
Recalculated
Original
Unmodified
Allowance
New Service
Unmodified
Allowance
New
Unmodified
Allowance
X X
= =
0.500 years 2.300% 1.150% $5,500
$63.25
=
X
=
X
Service
Credit
After
Reinstate-
ment
Benefit
Factor
on 2
nd
Retirement
Date
% of
Final
Compen-
sation
Final
Compen-
sation
Reinstate-
ment
Unmodified
Allowance
Your actual allowance
will depend on whether
you choose to name a
beneficiary to receive all
or some of your benefits
upon your death. For
simplicity, we will use the
Unmodified Allowance
for the first and second
retirement benefit.
Determined age is the age
at your second retirement
minus the number of
years and months you
were originally retired.
12 888 CalPERS (or 888-225-7377)
Sample Calculation
—
Classic/PEPRA
Barbara retired as a classic member and reinstated as a PEPRA member.
She earns five years of service credit and re-retires.
New retirement formula: PEPRA 2% at 62
PEPRA salaries: $5,500
Age at second retirement: 65.00 years
Original retirement formula: Classic 2% at 55 (local miscellaneous)
Classic salaries: $4,500
Determined age: 65.00 – 2.00 = 63.00 years
Barbara’s new benefit is $632.50 + $2,720.25 = $3,352.75*
* The data used in this example is hypothetical and is not based on any real-life person(s).
Final compensation may be affected by allowable special compensation, service
coordinated with Social Security, and/or applicable compensation caps.
X X
= =
5.00 years 2.300% 11.50% $5,500
$632.50
=
X
=
X
Service
Credit
After
Reinstate-
ment
Benefit
Factor
on 2
nd
Retirement
Date
% of
Final
Compen-
sation
Final
Compen-
sation
Reinstate-
ment
Unmodified
Allowance
X X
= =
25.00 years 2.418% 60.45% $4,500
$2,720.25
=
X
=
X
Service
Credit on
Original
Retirement
Determined
Age
Factor
% of
Final
Compen-
sation
Final
Compen-
sation
Recalculated
Original
Unmodified
Allowance
13www.calpers.ca.gov
Sample Calculation
—
Classic/Classic
Keith retired as a classic member and reinstated as a classic member.
He earns three years of service credit and re-retires.
New retirement formula: Classic 2% at 55 (state miscellaneous)
New salaries: $7,500
Age at second retirement: 63.00 years
Original retirement formula: Classic 2% at 55 (state miscellaneous)
Original salaries: $5,000
Determined age: 63.00 – 4.00 = 59.00 years
Keith’s new benefit is $562.50 + $3,375.00 = $3,937.50*
* The data used in this example is hypothetical and is not based on any real-life person(s).
Final compensation may be affected by allowable special compensation, service
coordinated with Social Security, and/or applicable compensation caps.
X X
= =
3.00 years 2.500% 7.50% $7,500
$562.50
=
X
=
X
Service
Credit
After
Reinstate-
ment
Benefit
Factor
on 2
nd
Retirement
Date
% of
Final
Compen-
sation
Final
Compen-
sation
Reinstate-
ment
Unmodified
Allowance
X X
= =
20.00 years 2.250% 45.00% $7,500
$3,375.00
=
X
=
X
Service
Credit on
Original
Retirement
Determined
Age
Factor
% of
Final
Compen-
sation
Final
Compen-
sation
Recalculated
Original
Unmodified
Allowance
14 888 CalPERS (or 888-225-7377)
HOW TO REINSTATE FROM SERVICE RETIREMENT
Notify the Right People
If you are currently working as a retired annuitant and want to accept a
permanent position with another CalPERS-covered employer, you must inform
your current employer. You cannot be an active permanent employee and a
retired annuitant at the same time.
Get a Firm Start or Hire Date
Make sure your actual start or hire date with your future employer is after
your retirement date. If you return to work before your actual retirement
date, you are not officially retired and you may owe us for any retirement
benefits you received. Your employment start date is the first day you
physically return to work.
Submit Your Reinstatement From Service Retirement
Application Form
The application form is located in the back of this publication and in the
Forms & Publications area of our website at www.calpers.ca.gov. Prior
approval is not needed before you start working. Once we receive your
completed application, we will confirm your start date with your employer
and provide you written confirmation of your retirement end date and
reinstatement start date.
Due to the timing of processing your reinstatement application and our
calendar cut-off dates for issuing retirement checks, you may incur an
overpayment of retirement benefits. For example, if your reinstatement
date is March 15, but the cut-off date for your April 1 check is March 8,
you will receive your full retirement check for the month of March and owe
us for 14 days of retirement benefits. If this happens, we will provide written
notification of the amount of overpaid benefits and instructions on how
to repay.
Important!
If your start date changes or you decide not to return to work and
you’ve already turned in your reinstatement application, you must
notify us immediately to avoid any disruption in benefit payments.
15www.calpers.ca.gov
HOW TO REINSTATE FROM DISABILITY OR
INDUSTRIAL DISABILITY RETIREMENT
Obtain Approval From CalPERS
If you retired on disability or industrial disability, you must have approval
from CalPERS before you can return to active employment for any
CalPERS-covered employer.
The reinstatement process can take three to six months, depending on how
complete your reinstatement application packet is and whether you will be
sent for an independent medical examination. Therefore, you will want to
submit your reinstatement request as far in advance as possible. You may
request a specific reinstatement date, but the effective date of employment
cannot be prior to the date of CalPERS’ approval.
Submit Your Reinstatement From Disability/Industrial
Disability Retirement Application Form
The application form is located in the back of this publication and in the
Forms & Publications area of our website at www.calpers.ca.gov.
If you are a local safety retiree who retired on a disability or industrial
disability retirement, and you want to return to any safety position
(public agency or state), submit your reinstatement application to your
former employer. They determine whether you’re eligible to return to work.
If you are a local safety retiree who retired on a disability or industrial
disability retirement, and you want to return to work in a miscellaneous
position with a CalPERS-covered employer, submit your reinstatement
application to CalPERS.
Submit Your Required Documentation
The reinstatement process and required documentation varies depending
on the employer you retired from and what position and employer you
want to work for.
For CalPERS to begin the determination process, you must submit
the following forms and documentation:
• Reinstatement From Disability/Industrial Disability
Retirement Application
• Authorization to Disclose Protected Health Information
• Physical Requirements of Position/Occupational Title
• Position Duty Statement
• Medical Clearance Report
16 888 CalPERS (or 888-225-7377)
You can find the forms in the back of this publication and in the
Forms & Publications area of our website at www.calpers.ca.gov.
If you are a local safety retiree who retired on a disability or industrial
disability retirement, and you want to return to work in a miscellaneous
position with a CalPERS-covered employer, you must also submit a position
duty statement describing the position you held when you became disabled
and the medical documentation used at the time of your retirement identifying
the restrictions placed upon you.
Submit Your Medical Clearance Report
Obtain a current medical report from your specialist and submit it to CalPERS.
If you had more than one disabling condition at the time of retirement, you
must provide a medical report from each medical specialist. The specialist(s)
must include in the medical report the following pertinent information:
• Your name and the date of the most recent examination.
• Your current diagnosis.
• Confirmation that the specialist(s) reviewed and discussed with you the
position duty statement(s) (by title) and the Physical Requirements of
Position/Occupational Title form(s).
–
State/CSU retirees: The confirmation should include the position
you retired from, in addition to the new position you have applied for.
• A statement as to whether you are presently capable of performing all tasks
involved in your new position with or without restrictions or limitations.
–
State/CSU retirees: The report should also include a statement as to
whether you are still incapacitated from performing all tasks for your
former position with or without restrictions or limitations. If you are still
incapacitated from the former position, state whether the incapacity is
permanent or temporary. If temporary, provide the expected duration.
• If there are restrictions or limitations, include specific details about
the restrictions for the new position.
–
State/CSU retirees: If there are restrictions or limitations, include
specific details about the restrictions for the former position.
• The specialist’s signature, printed name, medical specialty, and
contact information.
Sometimes we may need additional information or an independent medical
examination to supplement your medical specialist’s report. If so, CalPERS
will select the medical specialist, schedule the appointment, and pay for
the examination.
17www.calpers.ca.gov
Mandatory Reinstatement Rights
—
State or CSU Retirees
If you are a State of California or California State University (CSU) disability
retiree, you have mandatory reinstatement rights to your prior civil service
position from which you were found disabled. Your right to return depends
on medical clearance that your condition has improved to the point where
you can perform the essential functions of the position.
If you are medically cleared to return to the position from which
you retired and choose not to return, you will forever forfeit your
mandatory reinstatement rights to that position.
The chart below shows different scenarios for when your mandatory
reinstatement rights would be forfeited.
Scenario Reinstatement Rights
1
You retired on disability from
your position as an office
assistant. Your condition
improves, and you are medically
cleared to perform your former
office assistant job duties. You
find another office assistant job
that you’re interested in applying
for with another employer.
You may…
• return to your former position, or
• accept the new office assistant job
with the other employer.
You will forfeit your right to return
to your former position with the
employer you retired from
(Government Code section 21193).
2
You retired on disability from
your position as an office
assistant. Your condition
improves, and you are medically
cleared to perform your former
office assistant job duties.
You find another job within
the same classification as an
office assistant, which you’re
interested in applying for.
You may…
• return to your former position, or
• reinstate into the vacant position
in the same classification as your
former position as long as you are
first determined to be capable of
performing the new job duties. You
will forfeit your right to return to your
former position with the employer
you retired from (Government Code
section 21193).
3
You retired on disability from
your position as a cook. You
are still incapacitated from
performing your job duties as a
cook, but you were medically
cleared to perform a different
job. You are now working in that
new job. Later, you are medically
cleared to perform your former
cook job duties.
You may…
• reinstate to your former cook
position, or
• keep working in your new position
and forfeit your rights to return to
the cook position (Government
Code section 21193).
18 888 CalPERS (or 888-225-7377)
Scenario Reinstatement Rights
4
You retired on industrial
disability from your position as a
correctional officer. You reinstate
as an administrative assistant
under Government Code section
21197 because you were
determined to be capable of
performing those duties. Later,
you are medically cleared to
perform your former correctional
officer duties.
You may…
• reinstate into your former correctional
officer position, or
• remain in your administrative
assistant position and forfeit your
rights to return to your former
position. You will also no longer
be entitled to resume an industrial
disability retirement allowance
when you retire in the future
(Government Code sections 21193,
21197, and 21201).
Industrial Disability to Miscellaneous Position
Government Code section 21197 provides an industrial disability retiree
the right to reinstate into a miscellaneous position and then re-retire on
an industrial disability with no additional medical documentation.
When you retire again, we will take into consideration your membership
type (classic or PEPRA), additional earned service credit, contributions
made to CalPERS, and salaries when calculating your future industrial
disability retirement.
An industrial disability benefit pays the higher of:
• 50 percent of your highest consecutive 12-month or 36-month
average monthly salary. An additional annuity may be paid if you
have contributions associated with non-safety service.
• A service retirement allowance, if you qualify for service retirement.
• If under age 50, an actuarially reduced benefit factor (determined by your
retirement formula and how many quarter years you are under age 50)
multiplied by the number of years of service credit.
Remember, if your industrial disability benefit was based on
classic salaries, and you become subject to PEPRA in your new
miscellaneous position, your PEPRA salaries cannot be used toward
your classic service or vice versa.
19www.calpers.ca.gov
BECOME A MORE INFORMED MEMBER
CalPERS Website
Visit www.calpers.ca.gov for information on all our benefits and services.
You can also sign up to receive email newsletters and alerts.
myCalPERS
Log in at my.calpers.ca.gov to access real-time details and balances of your
CalPERS accounts. With myCalPERS you can:
• View, print, and save current and past statements.
• Select mailing preferences for your statements, newsletters, and retirement checks.
• Search for medical premium rates and health plans available in your area
and confirm which dependents are covered on your health plan.
• Estimate your future retirement benefit and save estimates to view later.
• Send and receive secure messages.
• Order and download publications.
• Send account information to third parties, such as banks.
• Apply for service retirement.
• Change your beneficiary designation.
• View the status of your service credit request, elected service credit details,
and payoff information.
• Retirees can update contact information, set up direct deposit, change tax
withholdings, and view annual tax statements.
CalPERS Education Center
Whether you’re in the early stages of your career or getting ready to retire,
visit the CalPERS Education Center in myCalPERS to:
• Take online classes to help you understand your benefits.
• Register for instructor-led classes and download class materials.
• Register to attend a CalPERS Benefits Education Event at a location near you.
• Schedule a one-on-one appointment at your nearest CalPERS Regional Office.
Experience CalPERS Through Social Media
Facebook: www.facebook.com/myCalPERS
Twitter: www.twitter.com/CalPERS
Instagram: www.instagram.com/CalPERS
YouTube: www.youtube.com/CalPERS
LinkedIn: www.linkedin.com/company/CalPERS
Reach Us by Phone
Call us toll free at 888 CalPERS (or 888-225-7377).
Monday through Friday, 8:00 a.m. to 5:00 p.m.
TTY: (877) 249-7442
20 888 CalPERS (or 888-225-7377)
Visit Your Nearest CalPERS Regional Office
Fresno Regional Office
10 River Park Place East, Suite 230
Fresno, CA 93720
Glendale Regional Office
Glendale Plaza
655 North Central Avenue, Suite 1400
Glendale, CA 91203
Orange Regional Office
500 North State College Boulevard, Suite 750
Orange, CA 92868
Sacramento Regional Office
Lincoln Plaza East
400 Q Street, Room 1820
Sacramento, CA 95811
San Bernardino Regional Office
650 East Hospitality Lane, Suite 330
San Bernardino, CA 92408
San Diego Regional Office
7676 Hazard Center Drive, Suite 350
San Diego, CA 92108
San Jose Regional Office
181 Metro Drive, Suite 520
San Jose, CA 95110
Walnut Creek Regional Office
Pacific Plaza
1340 Treat Boulevard, Suite 200
Walnut Creek, CA 94597
Visit the CalPERS website for directions to your local office.
Regional Office hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.
21www.calpers.ca.gov
PRIVACY NOTICE
The privacy of personal information is of the utmost importance to
CalPERS. The following information is provided to you in compliance with
the Information Practices Act of 1977 and the Federal Privacy Act of 1974.
Information Purpose
The information requested is collected pursuant to the Government Code
(sections 20000 et seq.) and will be used for administration of Board duties
under the Retirement Law, the Social Security Act, and the Public Employees’
Medical and Hospital Care Act, as the case may be. Submission of the requested
information is mandatory. Failure to comply may result in CalPERS being
unable to perform its functions regarding your status. Please do not include
information that is not requested.
Social Security Numbers
Social Security numbers are collected on a mandatory and voluntary basis.
If this is CalPERS’ first request for disclosure of your Social Security number,
then disclosure is mandatory. If your Social Security number has already been
provided, disclosure is voluntary. Due to the use of Social Security numbers by
other agencies for identification purposes, we may be unable to verify eligibility
for benefits without the number.
Social Security numbers are used for the following purposes:
1. Enrollee identification
2. Payroll deduction/state contributions
3. Billing of contracting agencies for employee/employer contributions
4. Reports to CalPERS and other state agencies
5. Coordination of benefits among carriers
6. Resolving member appeals, complaints, or grievances with health plan carriers
Information Disclosure
Portions of this information may be transferred to other state agencies (such as
your employer), physicians, and insurance carriers, but only in strict accordance
with current statutes regarding confidentiality.
Your Rights
You have the right to review your membership files maintained by the System.
For questions about this notice, our Privacy Policy, or your rights, please write
to the CalPERS Privacy Officer at 400 Q Street, Sacramento, CA 95811 or
call us at 888 CalPERS (or 888-225-7377).
CalPERS is governed by the Public Employees’ Retirement Law and the Alternate
Retirement Program provisions in the Government Code, together referred to as the
Retirement Law. The statements in this publication are general. The Retirement
Law is complex and subject to change. If there is a conflict between the law and this
publication, any decisions will be based on the law and not this publication. If you
have a question that is not answered by this general description, you may make a
written request for advice regarding your specific situation directly to the CalPERS
Privacy Officer at 400 Q Street, Sacramento, CA 95811.
22 888 CalPERS (or 888-225-7377)
Please provide your name
as it appears on your
Social Security card.
Section 1
Information About You
Your Name (First Name, Middle Initial, Last Name) CalPERS ID or Social Security Number
Birth Date (mm/dd/yyyy) Daytime Phone Alternate Phone
Address
City State ZIP
Section 2
Employer Information
Employee’s Start Date is
the day the member
starts employment.
Section 3
Your Signature and Certification
I understand that reinstatement will terminate my current CalPERS retirement benefit and can change
the benefits I am entitled to receive in the future when I re-retire.
Your Signature Date (mm/dd/yyyy)
( )
( ) ( )
( )
Employee’s Start Date (mm/dd/yyyy) Employee’s Job Title (do not abbreviate)
Name of Employer CalPERS Business Partner ID
Employer Phone Employer Fax Employer Email
Address
City State ZIP
Employer Certification
I hereby certify, under penalty of perjury, that the above information is true, complete, and correct
to the best of my knowledge.
Authorized Employer Signature Date (mm/dd/yyyy
Print Name Title
By completing this form you are requesting to reinstate into active membership with a CalPERS-covered employer.
Prior CalPERS approval is not required. You must notify us immediately if your first day of compensated employment
changes. For important information about how reinstatement can affect your retirement benefits, refer to the publication
Reinstatement From Retirement (PUB 37).
Reinstatement From Service
Retirement Application
888 CalPERS (or 888-225-7377)
•
TTY: (877) 249-7442
Mail to:
CalPERS Retirement Benefit Services Division • P.O. Box 942711, Sacramento, California 94229-2711
PERS-BSD-145 (11/19) Page 1 of 1
This page intentionally left blank to facilitate double-sided printing.
888 CalPERS (or 888-225-7377)
•
TTY: (877) 249-7442
Reinstatement From Disability/Industrial
Disability Retirement Application
PERS-01M0036DMC (11/19) Page 1 of 1
Mail to:
CalPERS Disability & Survivor Benefits Division • P.O. Box 2796, Sacramento, California 95812-2796
Please provide your name
as it appears on your
Social Security card.
Section 1
Information About You
Your Name (First Name, Middle Initial, Last Name) CalPERS ID or Social Security Number
Address
City State ZIP
Prospective Employer
Prospective Job Title Estimated Start Date (mm/dd/yyyy)
Safety Members Requesting Reinstatement Under Government Code 21197
c
I am requesting reinstatement from an industrial disability retirement into a miscellaneous position under
Government Code section 21197. I have read the publication Reinstatement From Retirement (PUB 37)
and understand the requirements of this provision.
Section 2
Your Signature and Certification
By completing this form you are requesting to reinstate from disability or industrial disability retirement into active
membership with a CalPERS-covered employer. Prior CalPERS approval is required. You must submit additional
required documentation with this application. Refer to the publication Reinstatement From Retirement (PUB 37)
and the back of this form for details.
I understand that reinstatement will terminate my current CalPERS retirement benefit and can change
the benefits I am entitled to receive in the future when I re-retire.
Your Signature Date (mm/dd/yyyy) Phone
( )
Section 3
Employer Certification
It is our intent to hire for the following:
Name of Member
Name of Employer CalPERS Business Partner ID
Job Title Estimated Hire Date (mm/dd/yyyy)
Authorized Employer Signature
Title Date (mm/dd/yyyy) Phone
This offer is contingent upon written approval from CalPERS.
This section does not need
to be completed by all
employers. See the back
of this form for further
instructions.
( )
Section 1
Information About You
•
Complete all fields.
Section 2
Your Signature and Certification
Section 3
Employer Certification
•
Complete all fields.
State/CSU Retirees
If you are a State of California or California State University (CSU) retiree, please read the “Mandatory Reinstatement
Rights” section of the publication Reinstatement From Retirement (PUB 37) before accepting any employment.
•
Complete all fields.
State/CSU Retirees
If you are a State of California or California State University (CSU) retiree and are reinstating to the position
from which you retired on disability, the employer does not need to complete this section.
Local Safety Retirees
If you are a local safety retiree who retired on disability or industrial disability and you want to return to any
local safety position, you must submit this form to your former employer. They determine whether you are
eligible to return to work.
If you are a local safety retiree who retired on a disability or industrial disability retirement, and you want to
return to work in a miscellaneous position with a CalPERS-covered employer, submit this form to CalPERS.
You must also submit a position duty statement describing the position you held when you became disabled
and the medical documentation used at the time of your retirement identifying the restrictions placed upon you.
Additional Documentation
You must submit the following documentation along with this form:
•
Authorization to Disclose Protected Health Information form
•
Physical Requirements of Position/Occupational Title form
•
Current medical report from your specialist
•
Position duty statement from the prospective employer (Note: If you are a state/CSU retiree,
also include a position duty statement from the employer you retired from.)
Instructions for Completing Form
PERS-01M0036DMC (11/19)
Section 1
Member Information
Name of Member (First Name, Middle Initial, Last Name) Social Security Number or CalPERS ID
Daytime Phone Evening Phone
Address
City State ZIP
I authorize the disclosure of my protected health information, including, but not limited to, medical histories,
diagnoses, examination reports, chart notes, testing and test results, X-rays, operative reports, lab and
medication records, prescriptions, and any other records relating to the prognosis, treatment or diagnosis of any
physical, mental, psychological or psychiatric condition, to the California Public Employees’ Retirement System
(CalPERS) or its representative, for the sole purposes of determining my physical or mental condition, illness, or
disability and my right, if any, to retirement or reinstatement under the Public Employees’ Retirement Law (PERL)
(Government Code sections 20000, et seq.). I understand that any information about me disclosed pursuant to
this Authorization will be used by CalPERS for the administration of its duties under the PERL, the Social Security
Act, and the Public Employees’ Medical and Hospital Care Act. I understand that submission of the requested
information is mandatory under Government Code section 20128 and that failure to supply the information
requested may result in CalPERS being unable to make a determination regarding my status.
This Authorization applies to any and all health and/or medical related information about me in the possession
of any health care provider, health plan, insurance company or fund, employer or plan administrator, government
agency, organization or entity administering a benefit program, rehabilitation organization or program.
I understand that if my protected health information is disclosed to someone who is not required to comply
with federal privacy protection regulations, that information may be re-disclosed and would no longer
be protected.
I understand that I have a right to revoke this Authorization at any time. My revocation must be in writing by
letter directed to the CalPERS Disability & Survivor Benefits Division at the address below. I am aware that my
revocation is not effective to the extent that persons I have authorized to use and/or disclose my protected health
information have acted in reliance upon this Authorization. Unless canceled by me in writing, this Authorization
shall be valid for four years from the date shown below. A photocopy of this Authorization shall be as valid as
the original. I understand that I may request a copy of this Authorization at any time.
( ) ( )
Section 2
Authorization to Release Information
I also authorize the disclosure of any and all personnel and other employment-related records on file
with any of my present or former employers which relate to my job duties, work performance, and other
work-related issues including, but not limited to, attendance and sick leave records and records of
administrative and judicial action arising out of, or related to, my past or present employment.
Signature of Member Date (mm/dd/yyyy)
Mail to:
CalPERS Disability & Survivor Benefits Division • P.O. Box 2796, Sacramento, California 95812-2796
PERS-BSD-35 (12/19) Page 1 of 1
Authorization to Disclose
Protected Health Information
888 CalPERS (or 888-225-7377)
•
TTY: (877) 249-7442
•
Fax: (916) 795-1280
This page intentionally left blank to facilitate double-sided printing.
Name of Member (First Name, Middle Initial, Last Name) Social Security Number or CalPERS ID
Position/Occupational Title Name of Employer
Section 1
Member Information
Activity Never/Rarely
< 5 min.
Infrequently
5-30 min.
Occasionally
31 min.-2.5 hrs.
Frequently
2.5-5.0 hrs.
Constantly
> 5 hrs.
Interacting/communicating:
Face-to-face with public
By phone with public
With inmates, patients,
or clients
With co-workers
Supervising staff
Lifting/Carrying:
0
-
10 lbs.
11
-
25 lbs.
26
-
50 lbs.
50
+
lbs.
Sitting
Standing
Walking
Running
Crawling
Kneeling
Climbing
Squatting
Bending (neck)
Bending (waist)
Twisting (neck)
Twisting (waist)
Reaching (above shoulder)
Reaching (below shoulder)
Section 2
Usual Job Duties of Position
Continued on page 2.
Physical Requirements of
Position/Occupational Title
PERS01M0050DMC (12/19) Page 1 of 2
Employer: You must
be familiar with the
member’s position as it
is usually performed.
Indicate with one check
mark (
) per activity
the duration of each
activity required to
carry out the member’s
usual job duties.
The total of these
activities should not
exceed the usual hours
worked per day.
This form must be completed by your employer based on the usual job duties of your position.
Both you and your employer must sign this form. We advise you sign this form together.
Usual hours worked per day: _______
Has the member been through the reasonable accommodation process?
c
Yes
c
No
If yes, provide CalPERS with the documentation/reasonable accommodation form.
888 CalPERS (or 888-225-7377)
•
TTY: (877) 249-7442
•
Fax: (916) 795-1280
Activity Never/Rarely
< 5 min.
Infrequently
5-30 min.
Occasionally
31 min.-2.5 hrs.
Frequently
2.5-5.0 hrs.
Constantly
> 5 hrs.
Pushing and pulling
Power grasping
Handling
(holding, light grasping)
Fine fingering
(pinching, picking)
Computer use
(keyboard, mouse)
Walking on uneven ground
Driving
Operating hazardous
machinery
Exposure to excessive noise
Exposure to extreme
temperature
Exposure to dust, gas,
fumes, or chemicals
Working at heights
Section 2 (continued)
Usual Job Duties of Position, continued
Signature of Employer Representative Date (mm/dd/yyyy)
Title Phone Number
Signature of Member Phone Number Date (mm/dd/yyyy)
( )
( )
Section 3
Signature of Employer
Section 4
Signature of Member
PERS01M0050DMC (12/19) Page 2 of 2
Mail to:
CalPERS Disability & Survivor Benefits Division • P.O. Box 2796, Sacramento, California 95812-2796
You must provide this
form and your job duty
statement to your medical
specialist for review.
Employer: If there is
not enough space to
enter all the additional
requirements, attach
a separate sheet. Be
sure to clearly write the
member’s name and
Social Security number
or CalPERS ID on
each attachment.
Once you have signed this section, your employer must provide you with a copy.
If you do not agree with your employer’s assessment, please provide your comments below. If needed, you may
complete a new form, which you can find at www.calpers.ca.gov.
Once you have completed and signed this form, please have the member sign Section 4.
You must send the original to CalPERS.
Your Name Social Security Number or CalPERS ID
Put your name and Social
Security number or CalPERS ID
at the top of every page.
This page intentionally left blank to facilitate double-sided printing.
California Public Employees’ Retirement System
400 Q Street
P.O. Box 942701
Sacramento, CA 94229-2701
888 CalPERS (or 888-225-7377)
www.calpers.ca.gov
PUB 37
January 2020
2020.1.1
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

A Guide To CalPERS Reinstatement From Retirement (PUB 37) (California)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 2 August 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document