REV 20181012
ESRR
Certifying Employee Status Under Retirement
Reemployment Laws
Please print or type in black ink.
Section A. Tell us about yourself.
FIRST NAME
MI LAST NAME
SSN (last 4 digits)
MAILING ADDRESS
MEMBER ID (if known)
CITY
STATE
ZIP CODE
DATE OF BIRTH
Section B. Please understand that retirees are subject to earnings restrictions.
Retirees may be subject to earnings restrictions upon returning
to work. State return-to-work laws require suspension of
retirement benefits when earnings from applicable employers
exceed the allowable limit. Before returning to work, be sure
that you understand the return-to-work laws that apply to the
System from which you retired. For example, new retirees
in the Teachers' and State Employees' Retirement System
Section C. Please tell us if you are receiving a monthly benefit from any of the systems below.
YES, I am currently receiving a monthly benefit from the following: (check all that apply)
NO, I am not currently receiving a monthly benefit from any of the above listed systems.
Thank you.
N.C. Department of State Treasurer, Retirement Systems Division
3200 Atlantic Avenue, Raleigh, North Carolina 27604
(919) 807-3050 in the Raleigh area or (877) 627-3287 toll free
www.myncretirement.com
Page 1 of 1
POSITION TITLE
TELEPHONE NUMBER
Section D. Please sign below.
I certify that I have read the Guides and the information I provided in Sections A and C is correct to the best of my knowledge. I
understand that if my employment subsequently creates an overpayment of benefits from the Retirement Systems Division, I am
fully responsible for the repayment of the said overpayment.
Member's Signature _______________________________________________________ Date _________________________
SUFFIX
(TSERS) may not work with a TSERS employer, or make
arrangements for future work, until the first six months of
retirement have passed. A summary of return-to-work laws for
the Local Government Employees' Retirement System and the
Teachers' and State Employees' Retirement System is located
in Guides B, C, and D.
Teachers' and State Employees' Retirement System (TSERS)
Local Governmental Employees' Retirement System (LGERS)
Consolidated Judicial Retirement System (CJRS)
Legislative Retirement System (LRS)
Disability Income Plan of North Carolina (DIPNC)
Section E. Please submit this form to your employer.
Please do not send this form to the Retirement Systems Division (RSD). Your employer should retain this form.
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REV 20181012
ESRR
Guides for Certifying Employee Status
Under Retirement Reemployment Laws
Page 1 of 2
GUIDES
Guide A. What is the purpose of this form and why does this form need to be completed?
Report any known rehired retirees who may be subject to the
earnable allowance to RSD through the ORBIT system.
If a member falsifies this document (Form ESRR) by not
reporting himself/herself as a benefit recipient,
the employer will
not be penalized. However, if the employee exceeds his/her
earnable allowance, or violates other return-to-work laws, the
employee will be held fully responsible for repaying any
overpayment to RSD.
Effective July 1, 2009, employers are required to report any
rehired retirees to the Retirement Systems Division (RSD) or the
employer will incur a penalty. In order for employers to avoid a
potential penalty, RSD asks employers to take the following
steps:
Obtain signed documentation (Form ESRR) from
the employee stating he/she is or is not currently receiving a
monthly benefit from RSD.
Guide B. What are the return-to-work laws?
After you have officially retired and are receiving mont
hly
benefits,
if you perform work in any capacity for an employer under
the same Retirement System from which you retired, you will be
subject to the reemployment provisions described below. These
provisions may require you to work under an earnings limitation or
to reenroll as a contributing member of the Retirement System.
You will be subject to reemployment provisions based on the
nature of the particular work you perform for a covered
employer, regardless of your job classification or your technical
employment status (which may include being assigned to work for
a covered employer by a private company such as a temporary
staffing agency).
Return-to-work laws apply differently to members of TSERS,
LGERS, CJRS, and LRS. Following return-to-work laws will
protect you from incurring financial penalties, possible loss of
retirement benefits, and loss of health benefits received
through the State Health Plan.
If you are retired under LGERS, see Guide C for more detailed
information.
If you are retired under TSERS, see Guide D for more detailed
information.
If you are retired under LRS and y
ou perform w
ork which
requires you to be a contributing member o
f TSERS, CJRS or LRS,
your LRS benefit will be suspended and you will be required to
enroll or reenroll as a contributing member of the System under
which you are working. A summary of LRS return-to-work laws
is located in the LRS Handbook, Your Retirement Benefits,
located on our website at www. myncretirement.com.
If you are retired under CJRS and you perform work which
requires you to be a contributing member of TSERS or CJRS, your
CJRS benefit will be suspended and you will be required to enroll or
reenroll as a contributing member of the System under which you
are working. If you are retired under CJRS and you perform work
in any capacity for a TSERS employer that does not require you to
become a member of TSERS, you will be subject to an earnings
limitation. A
summary of CJRS return-to-work laws is located in
the CJRS Handbook, Your Retirement Benefits, located on
our website at www. myncretirement.com.
If you receive a disability benefit from any System, please
contact the Retirement Systems Division for information on
reemployment provisions that apply to you.
Guide C. Return-to-work laws for Local Governmental Employees' Retirement System retirees
LGERS members cannot return to work for an LGERS
employer during the month in which their retirement became
effective. If you violate this law, your LGERS retirement benefit will be
cancelled and all retirement benefits paid to you must be repaid to
the Retirement System. If you have employer-provided
health coverage, you may wish to discuss with your employer
how the cancellation of your retirement benefit will affect the
health coverage.
After a one-month break, if you wish to perform services for an
LGERS employer and continue to receive your LGERS
monthly retirement benefit, you must meet the following
conditions:
N.C. Department of State Treasurer, Retirement Systems Division
3200 Atlantic Avenue, Raleigh, North Carolina 27604
(919) 733-4191 in the Raleigh area or (877) 733-4191 toll free
www.myncretirement.com
(NOTE: if you are reemployed by an LGERS employer in a
regular position which requires 1,000 or more hours of work per
year, your retirement payment must be stopped and you will again
become a contributing LGERS member.)
You are subject to the earnings restrictions below. You
can earn whichever is greater:
(a) 50% of your compensation, excluding
termination payments, reported to the Retirem
ent System during
the 12 months of service preceding the effective date
of your retirement, or
(b) $31,140.00 (for 2014).
These earnings restrictions apply for the 12
months
immediately following retirement and for each calendar year
following the year of retirement.
You must work in a position that does not require membership in
LGERS.
Please continue to next page.
REV 20181012
ESRR
Page 2 of 2
GUIDES
These guides are subject to and governed by the General Statutes of the State of North
Carolina.
Guides for Certifying Employee Status
Under Retirement Reemployment Laws
N.C. Department of State Treasurer, Retirement Systems Division
3200 Atlantic Avenue, Raleigh, North Carolina 27604
(919) 733-4191 in the Raleigh area or (877) 733-4191 toll free
www.myncretirement.com
Return-to-work laws are much more extensive than presented
above. For information on LGERS return-to-work laws, please visit
our web site at www.myncretirement.com to view:
Guide C. Continued
Return-to-Work laws in the "Benefit Recipients" section
Your Retirement Benefits Handbook
(a) 50% of your compensation, excluding termination
payments, reported to the Retirement System during the 12
months of service preceding the effective date of your
retirement, or
(b) $31,140.00 (for 2014)
These earnings restrictions apply for the 12 months
immediately following retirement and for each calendar year
following the year of retirement.
If you are retired under TSERS and you perform work
which
requires you to be a contributing member of CJRS, your
TSERS benefit will be suspended and you will be required to enroll
as a contributing member of CJRS.
Return-to-work laws are much more extensive than presented above.
For information on TSERS return-to-work laws, please visit our web
site at www.myncretirement.com to view:
Return-to-Work laws in the "Benefit Recipients" section
Your Retirement Benefits Handbook
Guide D. Return-to-work laws for Teachers' and State Employees' Retirement System retirees
TSERS members must be retired at least six months before
returning to work for a TSERS employer in any capacity
(except as a bona fide volunteer in a local school
administrative unit, a school board member, a member of a board
of trustees of a community college or of any constituent institution of
the University of North Carolina, or an unpaid bona fide volunteer
guardian ad litem in the Guardian ad Litem Program). If you violate
this law, your TSERS retirement benefit must be cancelled and
all TSERS retirement benefits paid to you must be repaid to
the Retirement System. Your State Health Plan coverage also
must be cancelled if your retirement benefit is cancelled.
After a six-month break, if you wish to return to work with a
TSERS employer and continue to receive your TSERS
monthly retirement benefit, you must meet the following
conditions:
• You must work in a position that does not require membership in
TSERS. (NOTE: If you are reemployed in a TSERS position which
requires you to be a permanent employee who works at least 30
hours per week for nine months per year, your retirement payment
must be stopped and you will again become a contributing TSERS
member.)
• You are subject to the earning restrictions below. You can