Employer Signature
I have veried the information above using MRV or by contacting a DRS representative. I acknowledge that failure to properly report
a retiree to DRS can result in a liability to the employer.
Employer Signature Date
Employer Comments (optional)
Please enter any additional comments here. If you need more room, use the back of this form and check this box: c
Employee Information
Employer
Verication
Employee Name (Last, First, Middle) Social Security Number
Are you a retiree of one of Washington state’s retirement systems? If yes, which one(s)?
c Yes, _______________________________________________________________________________________ c No
c Yes c No
Are you a retiree of a separate retirement plan covered by the city of Seattle, Spokane or Tacoma?
If yes, which one(s)?
c Yes, _______________________________________________________________________________________ c No
If the employee checked yes,
stop. Contact ESS before
enrolling the employee in a
DRS retirement plan.
Are you currently employed by another public employer and contributing to a Washington state
retirement system? That is, will you be working at the same time for two public employers?
c Yes c No
If the employee checked yes,
stop. Contact ESS before
enrolling the employee in a
DRS retirement plan.
Employee Signature Date
Retirement Status
Verication
Employers can use this form to document
the retirement status of all new employees,
as required by RCW 41.50.139.
Contact Information for
Employer Support Services at DRS
360.664.7200, option 2
800.547.6657, option 6, option 2
employersupport@drs.wa.gov
Employer Instructions
RCW 41.50.139 requires employers to obtain, in writing, the retirement status of all new employees. Employers
can document retirement status through their own processes or by using this DRS form. If using this form,
follow these instructions:
• Ask the employee to complete and sign the Employee Information section below.
• Use Member Reporting Verication (MRV) to review the employee’s retirement status.
• Record the results in the Employer Verication section below.
• Determine whether the employee retired using the 2008 Early Retirement Factors. c Yes c No
If yes, contact DRS Employer Support Services (ESS) immediately.
• Use Retiree Return to Work (RRTW) Reporting Charts to review reporting instructions as necessary.
• Sign and date this form.
• Retain this form for 60 years.
*DRSMS147*
DRS MS 147 (5/16)
