Fillable APPLICATION FOR PURCHASE OF PRIOR SERVICE CREDIT

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APPLICATION FOR PURCHASE OF PRIOR SERVICE CREDIT

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*VRS-000026*
VRS-26 (Rev. 08/17)
APPLICATION FOR PURCHASE OF PRIOR SERVICE CREDIT
Complete this application to purchase service that your current employer cannot certify. If you worked in a non-
covered position with a former employer that participated in VRS during your service period, submit the form to that
employer. If you worked in federal or public service, your former employer and retirement system must complete
parts B and C. For VRS refunded service not already in your record, complete part A and send this form to VRS.
If you choose to purchase service from more than one employer, complete a separate application for each employer.
PART A. MEMBER INFORMATION
3. Name (First, MI, Last)
4. Mailing Address (Street, City, State, ZIP+4)
5. Previous Name(s) Used
6. Birth Date
7. Type of Service Requested
Non-Covered Service with former employer that participated in VRS, though you were not eligible for VRS
coverage at that time. Your service will be calculated as one month of service for each 173 hours you worked, as
certified by your former employer. Qualifying types of service include: part-time or wage service, probationary service,
Job Partnership Training Act (JPTA) service, Comprehensive Employment Training Act (CETA) service, and grant-
funded service with a VRS-participating employer. Your period(s) of service must fall within the employer’s retirement
coverage dates in VRS. During this time, your employer must not have contributed to an optional retirement plan or
another retirement plan on your behalf; you may not receive a pension from any of the plans.
Public or federal service in other government agency not entitling you to a benefit with the employer’s retirement
system or any other public retirement benefit. Public service is permanent, full-time, salaried service with another
state agency, public school system, public institution of higher learning, or political subdivision in this or another state
or territory of the United States. Federal service is permanent, full-time, salaried service with a federal agency.
Service with a private employer is not eligible.
Previously refunded VRS service earned prior to July 1988
8. Employer at Time of Service
9. Dates of Service
From: Through:
10. Are you entitled to a retirement benefit from a former retirement system as a result of the service listed above?
Yes No
11. Member Certification:
I certify the following: 1) the requested prior service credit shall not be used in the calculation of any retirement benefit
received or to be received from any other retirement system with the exception of Armed Services Reserve or National
Guard pensions; 2) I am neither now receiving, nor entitled to receive, a benefit from any retirement system based on the
service indicated above and 3) all statements made by me, the undersigned member, are true and correct.
I understand that: 1) any person who knowingly makes any false statement or falsifies or permits the falsification of any
record related to eligibility for membership in the VRS Trust Fund in any attempt to defraud the Fund shall be guilty of a
Class 1 misdemeanor; 2) if the employer is unable to certify the requested service, the purchase will not be allowed; 3) if
an error or misrepresentation is discovered, any adjustments to my account may affect my retirement benefits and 4) by
signing below, I give permission for my previous employer and/or retirement system to release information about the
requested service.
Member’s Signature Date
1. Social Security Number
2. Phone Number
VIRGINIA RETIREMENT SYSTEM
P.O. Box 2500 Richmond, Virginia 23218-2500
Toll-free 1-888-VARETIR (827-3847)
Fax 804-786-9718
www.varetire.org
Clear Form
VRS-26 (Rev. 08/17)
PART B. EMPLOYER CERTIFICATION OF SERVICE
(Human Resources Representative: Complete this section.)
Type of Service/Leave Credit to be Purchased
From
(Month/Year)
Through
(Month/Year)
13. Non-Covered Service with former employer that participated in VRS
Total Hours: ____________________
14. Federal Service
(Permanent, full-time, salaried. Identify any breaks in service in the section below.)
15. Public Service
(Permanent, full-time, salaried. Identify any breaks in service in the section below.)
16. Explanation of breaks in service (for federal or public service)
17. Name of retirement system or plan in which member participated (for federal or public service)
18. Certification
I hereby certify that the service/leave period listed above is true and correct based on official records. For federal or public
service, I hereby certify that this individual was engaged in public or federal employment in a permanent, full-time, salaried
position with a state agency, public school system, public institution of higher learning, political subdivision in this or another
state or territory of the United States, or with a federal agency during the above stated time period. Service with a private
employer is not eligible. Further, to my knowledge, the service/leave period listed above is not used in the calculation of any
retirement benefit received or to be received from any other retirement system, with the exception of Armed Services
Reserve or National Guard pensions.
The Code of Virginia §51.1-124.10 states that any person who knowingly makes any false statement or falsifies or permits
the falsification of any record related to eligibility for membership in the VRS Trust Fund in any attempt to defraud the Fund
shall be guilty of a Class 1 misdemeanor.
Signature Phone Date
Printed Name Title
Employing Agency Name Address
____________________________________________________
VRS 5-digit Employer Code (if it applies) City/State/ZIP
12. Social Security Number
VRS-26 (Rev. 08/17)
PART C. FORMER RETIREMENT SYSTEM CERTIFICATION
The individual identified in Part A would like to establish credit for federal or public (out-of-state or in-state) service with the Virginia
Retirement System. This service may include employment with a federal agency, state agency, school board or political subdivision
in this or another state or territory of the United States. Virginia law does not permit the purchase of this credit if the individual is
eligible to receive a benefit under another retirement system/plan as a result of such employment.
20. Does the service listed in Part B accurately reflect the service in your system? Yes No
If no, enter dates of service: From: To:
21. Has this individual withdrawn all eligible contributions from your retirement system? Yes No
22. Certification (Choose the appropriate statement)
On the basis of official records, I hereby certify the service listed in Part B of this application is not used in the
calculation of any retirement benefit the applicant is receiving or is entitled to receive from this retirement system with
the exception of reserve or national guard pensions.
On the basis of official records, I hereby certify the service listed in Part B of this application is used in the
calculation of a retirement benefit the applicant is receiving or is entitled to receive from this retirement system with
the exception of Armed Services Reserve or National Guard pensions.
Comments:
Signature Phone Date
Preparer’s Printed Name Title
Retirement System/Plan Name Address
City/State/ZIP
This application must be returned to your current employer for processing unless you are requesting previously
refunded VRS service not already reflected in your member record or non-covered service with an employer with
whom you are no longer employed. In these cases, return the application directly to VRS.
Remember: Do not scan/email this form to VRS to ensure the security of member information included on this form.
19. Social Security Number
VRS-26 (Rev. 08/17)
COMPLETING THE APPLICATION FOR PURCHASE OF PRIOR SERVICE CREDIT
Purchasing prior service credit increases your total years of service and counts toward the five years needed to
become vested, your eligibility for retirement and the retiree health insurance credit. You may purchase prior
service credit if you have ever received a VRS refund and returned to covered employment, or if you have other
types of service, such as public service, that you are eligible to purchase. You may purchase all or part of your
eligible service as long as it does not overlap with other VRS service or qualify you for benefits under another
retirement plan.
IMPORTANT NOTE: For most types of service, you can contact your employer directly. This application is
only used for service that cannot be certified by your current employer (which includes non-covered
service with a former employer who participated in VRS during your service period, other public service,
or federal service that is not considered military service).
WHEN TO APPLY
You must apply for and pay for prior service credit while you are an active member. Keep in mind the cost to
purchase service generally increases over time, or if your salary increases before you begin a purchase.
APPLYING FOR ELIGIBILITY
1. Review your prior service eligibility in myVRS to determine if any eligibility is missing. To review your
eligibility, create an online account in myVRS at myvrs.varetire.org. Once you have logged into your account,
select “Purchase Prior Service” from the Manage My Benefits drop-down menu.
2. If you have eligible service not listed in myVRS, contact your employer directly to have your service certified.
If you are applying for the service types listed on this form, complete Part A of the application and enter your
Social Security number at the top of each page. Remember: If you request a purchase of service credit from
more than one employer, complete separate applications for each employer.
3. Submit the form as indicated below, based on the type of service you are requesting:
For VRS refunded service not already in your record: Complete Part A and send the form to VRS.
For non-covered service: Forward the application to the employer where the service was earned. Have this
employer certify the prior service. If the employer certifying your service is not your current employer, send
the form to VRS.
For federal or public service: Have the employer forward the application to the retirement system in which
you participated. The retirement system must complete Part C and return the form to you. Your current
employer will add the eligibility into the VRS system after the retirement system has completed the
certification.
REVIEWING YOUR ELIGIBILITY
After your prior service is certified by your employer and entered into the VRS system, you will see the service
periods displayed in myVRS. (Select “Purchase Prior Service” from the Manage My Benefits drop-down menu to
view a summary of your eligibility.) If applicable, this display includes information about how your future retirement
is affected by a purchase of service.
REVIEWING THE COST OF YOUR PURCHASE
In your online myVRS account, you can view the cost to purchase the service. When you review your options for
purchase, the type of cost is displayed as well as the date the cost may change.
VRS-26 (Rev. 08/17)
If you begin your purchase of prior service credit within two years of becoming employed in a covered position or
following an eligible period of leave, the cost will be at a rate approximating the normal cost for the retirement plan
under which you are covered. Approximate normal cost may be generally defined as the cost of one year of VRS
service credit. After two years of being eligible to purchase a period of service, the cost of that period of service
will change to an actuarial cost which is the amount of money needed in today’s dollars to pay for the increase in
your future retirement benefit or an earlier retirement date resulting from the purchase of prior service.
For periods of refunded service, the cost is the withdrawn amount to be purchased plus interest accrued daily and
compounded annually from the date of the withdrawal to the date of payment at an assumed rate of return
determined at the time of the purchase.
PAYING FOR YOUR PURCHASE OF ELIGIBLE SERVICE
Once you have selected the service you would like to purchase in myVRS, you will select the order in which the
service will be posted into your VRS record. (For example, a VRS member eligible for hazardous duty benefits
may prefer to purchase a service period that is certified as hazardous to be eligible for the hazardous benefits
before selecting other service to purchase.)
After selecting the order, you will choose how to pay for this service. You may choose to pay for prior service
credit by pre-tax salary reduction (if offered by your employer), post-tax payroll deduction, lump-sum payment or a
combination of these methods. Lump-sum payment options include a personal check, a rollover from a qualified
plan, or a trustee-to-trustee transfer. Detailed information about each type of payment is available on the VRS
website under “Purchase of Prior Service” (www.varetire.org/pps).
When you select a lump-sum purchase in myVRS, you will indicate the source of funds for your payment.
After selecting your payment options and entering any subsequent information, you will confirm your purchase,
print your confirmation page and initiate the purchase(s) you selected. If you selected a payment agreement, you
must provide a copy of the confirmation to your employer for processing. If you selected a lump-sum payment,
you will send the payment(s) as instructed in myVRS.
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APPLICATION FOR PURCHASE OF PRIOR SERVICE CREDIT

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Completed 18 July 2021

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