Fillable Election to Participate in Optional Retirement Program and/or (University of Texas System)

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Election to Participate in Optional Retirement Program and/or (University of Texas System)

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1000 Red River Street
Austin, TX 78701-2698
(800) 223-8778
www.trs.texas.gov
Teacher Retirement System of Texas Page 1 of 3
Election to Participate in Optional
Retirement Program and/or Refund
TRS28 (08-19)
Section 1 - Member Information
Name
Social Security Number
Address
Street Address or PO Box Number City State Zip Code
Phone Number Date of Birth
To be completed if your refund will be sent to a foreign address:
Are you a U.S. citizen? Yes No
If you are not a U.S. citizen, are you a resident alien of the U.S.? Yes No
If you answered no to both questions above, see page 1 of the Information Sheet for ORP Election and/or Refund
(TRS28IN) for additional information regarding required federal income tax withholding.
Section 2 – Prior Optional Retirement Program Election Information
Have you previously elected the Optional Retirement Program in lieu of TRS? Yes No
If yes, institution name __________________________________ dates of employment ___________________
If yes, you are not eligible to elect ORP a second time.
Section 3 – Member Election
I elect to participate in the Optional Retirement Program (ORP) established under Chapter 830, Texas Government
Code, in lieu of membership in the Teacher Retirement System of Texas (TRS). I understand that by this election I will
not be eligible for membership in TRS unless I cease to be employed by an institution of higher education and become
employed by the Texas public school system other than in an institution of higher education. I further understand that by
electing ORP, I forfeit all accrued rights to benefits from TRS, if any, including benefits based on TRS service credit
accrued prior to this election. I am entitled only to a refund of my TRS accumulated contributions, if any. I understand
this election is irrevocable.
Section 4 – Refund Election (select one)
Refund
I elect to have my TRS accumulated contributions paid directly to me. I understand that 20% of
the taxable amount of my refund will be withheld for federal income taxes (provided the
amount is greater than $200.00). See page 2 of the Information Sheet for ORP Election and/or
Refund (TRS28IN) for information on tax withholding if you are not a U.S. citizen or resident
alien of the U.S.
Direct Rollover
I elect to have all or a portion of my TRS accumulated contributions rolled over into an eligible
retirement plan. I understand that TRS will provide me with an additional form if this option is
selected. A Refund Rollover Election form (TRS6A) must be completed and returned to TRS.
No Refund
I elect to leave my accumulated contributions with TRS. I understand that I forfeit all accrued
rights to benefits based on my TRS service credit accrued prior to my election to participate in
ORP, if any, by electing ORP in lieu of TRS. I understand that I can apply for a refund at a
later date.
Be sure to include your name and Social Security Number on all 3 pages.
1000 Red River Street
Austin, TX 78701-2698
(800) 223-8778
www.trs.texas.gov
Teacher Retirement System of Texas Page 2 of 3
Election to Participate in Optional
Retirement Program and/or Refund
TRS28 (06-19)
Name Social Security Number
Section 5 – Payment Method for Portion Not Being Rolled Over
Check
I elect to have the portion of my refund paid directly to me sent to my mailing address as a
paper treasury warrant.
Direct Deposit
I elect to have the portion of my refund being paid directly to me sent electronically to the
financial institution listed below.
Be sure to include your name and Social Security Number on all 3 pages.
Name of Financial Institution __________________________________________________________________
Bank Routing Number
Account Type (must select one) Checking Savings
Account Number
The following declaration MUST be completed if you are requesting direct deposit. (select a, b, or c)
(a) These payments WILL NOT be forwarded to a country outside the United States.
(b) These payments WILL be forwarded, but less than 100%, to a country outside the United States.
(c) These payments WILL be forwarded in its entirely (100%) to a country outside the United States.
Specify the name of the country where 100% of payment(s) will be forwarded: ____________________________
Section 6 - Member Certification and Signature
I acknowledge that I have received a copy of the Information Sheet for ORP Election and/or Refund (TRS 28IN) and the
Special Tax Notice Regarding Your Rollover Options Under TRS, and that I have 30 days from receipt of the notice to
consider my decision of whether to elect a direct rollover of my distribution of accumulated contributions. I understand
that once I have made an election to roll over my refund and TRS has issued the distribution, my rollover is irrevocable
and cannot be changed.
__________________________________________________ _________________________
Signature Date
STATE OF _____________________________ COUNTY OF ____________________________________
On _________________________, ___________________________________ acknowledged this document before me
(date) (printed name of person whose signature appears above)
a notary public.
______________________________________________ (SEAL)
Signature of Notary Public
1000 Red River Street
Austin, TX 78701-2698
(800) 223-8778
www.trs.texas.gov
Teacher Retirement System of Texas Page 3 of 3
Election to Participate in Optional Retirement Program
and/or Refund
TRS28 (09-16)
Name Social Security Number
Section 7 - Employer Certification
This is to certify that the above named individual is eligible and has elected to participate in the Optional
Retirement Program in lieu of membership in the Teacher Retirement System of Texas.
Name of Institution of Higher Education _____________________________________________________
TRS Reporting Entity Number ________________
Date First Eligible to Elect ORP _________________
ORP Eligibility Notification Date _________________
ORP Election Date __________________
ORP Effective Date __________________
Report Month/Year for Final Deposit to TRS _____________
Printed Name of Reporting Official ________________________________________________________
Title of Reporting Official ________________________________________________________________
Signature of Reporting Official ____________________________________________________________
Date __________________
1000 Red River Street
Austin, TX 78701-2698
(800) 223-8778
www.trs.texas.gov
Teacher Retirement System of Texas Page 1 of 4Teacher Retirement System of Texas Page 1 of 4
Information Sheet for ORP
Election and/or Refund
TRS28IN (09-16)
Optional Retirement Program (ORP) Election
• The election of ORP in lieu of membership in the Teacher Retirement System of Texas (TRS) is
irrevocable.
• If you established membership in TRS prior to your election to participate in ORP, your membership in
TRS is terminated by your election to participate in ORP.
• All accrued rights to benefits from TRS, if any, are forfeited upon the election of ORP. This includes
any benefits associated with TRS service credit you accrued prior to your election to participate in
ORP, such as service or disability retirement benefits.
• Only one Election to Participate in Optional Retirement Program and/or Refund form (TRS28) should
be filed with TRS for ORP election purposes, as you may elect ORP only once in lieu of participation
in TRS. However, if you elect not to withdraw your TRS accumulated contributions at the time you
elect to participate in ORP, you may submit a second TRS28 only for purposes of requesting a
refund.
• The election to participate in ORP in lieu of membership in TRS must be made before the 91st day
after the date you become eligible to participate in ORP.
• If your employer notifies you of your eligibility to participate in ORP after the first date of eligibility, but
before the 91st day after the first day of eligibility, you must make your election before the later of the
91st day after the first day of eligibility or the 31st day after you were notified of eligibility. (If you are
unsure about your first date of eligibility, your employer will provide that date to you.)
• If your employer fails to notify you of your eligibility to participate in ORP before the 91st day after the
first you became eligible to participate, but notifies you before the 151st day after the first day you
become eligible, you must make your election before the later of the 151st day after the first day of
eligibility or the 31st day after you were notified of eligibility.
• If your employer fails to notify you of your eligibility to participate in ORP before the 151st day after
the first day of eligibility, you are not eligible to elect to participate in ORP and must remain a
participant of the TRS retirement plan.
Refund Election
A person who is a participant in ORP may withdraw their accumulated contributions from TRS; however, you
are not required to withdraw your accumulated contributions at the time you elect to participate in ORP. To
apply for a refund at a later date, you must submit a second TRS28. Please note that your account will not
accrue interest after your election to participate in ORP.
Federal Income Tax Implications
Refunded amounts that represent tax sheltered contributions are subject to a mandatory 20 percent federal
income tax withholding unless you elect to roll over all eligible amounts to another eligible retirement plan.
The amount withheld may not be sufficient to cover your income tax liability for the refund. A 10 percent early
withdrawal penalty assessed by the Internal Revenue Service (IRS) may also be applicable. All or a portion of
your refund that is eligible for rollover may be rolled over. For more information regarding amounts in your
TRS account that are eligible for rollover and types of retirement plans that are eligible to receive rolled over
amounts, see the Special Tax Notice Regarding Your Rollover Options Under TRS .
1000 Red River Street
Austin, TX 78701-2698
(800) 223-8778
www.trs.texas.gov
Teacher Retirement System of Texas Page 2 of 4Teacher Retirement System of Texas Page 2 of 4
Information Sheet for ORP
Election and/or Refund
TRS28IN (09-16)
If you are not a U.S. citizen or resident alien of the U.S., TRS is required to withhold 30 percent for federal
income tax unless you qualify for benefits under a U.S. tax treaty. If so, you must notify TRS of your
eligibility for reduced withholding or exemption from withholding and provide TRS with a completed IRS
Form W-8BEN (Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding) and
any other required documentation. The W8-BEN can be obtained on the IRS’ website, www.irs.gov, or from
TRS upon request. TRS recommends that you submit the completed Form W-8BEN with your TRS28 in
order to expedite the processing of your refund.
It is your responsibility to submit the proper tax returns to the IRS and to pay any additional taxes or
penalties that may be due. TRS encourages you to contact your professional tax advisor for specific advice
on how this distribution may affect your taxes.
Additional Information about Rollovers
If you elect either a full or partial rollover, TRS will make the treasury warrant for the rollover payable to the
trustee of the eligible retirement plan named on the Refund Rollover Election form (TRS6A). TRS will mail
the treasury warrant for the rollover to the address listed on your TRS28. You are responsible for
forwarding the treasury warrant to the plan receiving the rollover in order to complete the rollover.
If the amount you elect to roll over is less than the total amount in your account at the time of distribution,
TRS will pay any balance to you through a second payment, which will be payable to you and issued as
either a direct deposit or paper treasury warrant.
If the amount you elect to roll over is less than your account total, TRS will roll over your tax sheltered funds
first, then your non-tax sheltered funds to reach the total dollar amount you chose to roll over. If the amount
you wish to roll over is less than your tax sheltered amount, TRS will pay you the remaining tax sheltered
amount minus 20% for federal income tax withholding, plus any non-tax sheltered amount in your account.
Roth IRAs: A rollover to a Roth IRA results in a taxable distribution in the year in which it is paid by TRS. If
you choose to rollover to a Roth IRA, you must complete Section 3 of the TRS6A regarding your withholding
preference. TRS recommends that you consult with a professional tax advisor about whether the tax
sheltered amount of your refund is subject to the 10% additional tax on early distributions described in the
Special Tax Notice Regarding Your Rollover Options Under the TRS.
Foreign Trusts: A direct rollover may be made to a foreign trust that is part of a stock bonus, pension, or
profit sharing plan established outside the U.S., if the receiving foreign trust would qualify for exemption
from tax under Internal Revenue Code (IRC) §§ 401(a) and 501(a), except for the fact that it is a trust
created or organized outside the U.S. To claim this exemption, in addition to any other information required
by TRS, the distributee must furnish a written statement by an authorized official of the foreign trust stating
that the foreign trust is a trust described under IRC § 402(d). TRS will not make a rollover to a foreign trust
without this statement.
1000 Red River Street
Austin, TX 78701-2698
(800) 223-8778
www.trs.texas.gov
Teacher Retirement System of Texas Page 3 of 4Teacher Retirement System of Texas Page 3 of 4
Information Sheet for Optional Retirement
TRS28IN (09-16)
Tax Statements Sent by TRS
Tax statements (Form 1099-R) are required to be mailed to your address on record no later than January 31
of the year following a refund. Form 1099-R includes the total amount of the lump sum distribution, any
portion that is taxable income for the year paid, and the amount of income tax withheld. This information is
also provided to the IRS as required by federal law. If you are not a U.S. citizen or resident alien of the U.S.,
TRS will report your distribution on a Form 1042-S instead of on a Form 1099-R.
If you elect to roll over all or a part of your refund, you will receive a separate Form 1099-R regarding the
rollover amount. Tax statements are mailed to the same address used for refunds. You must notify TRS in
writing if your address changes after you receive your refund. TRS must receive your notification prior to
December 10 of the year in which you received your refund in order to ensure that the form will be sent to
the correct address.
Instructions
If you are electing ORP participation and requesting a refund of your TRS accumulated contributions:
1. Read the Special Tax Notice Regarding Your Rollover Options Under TRS.
2. Complete the Election to Participate in Optional Retirement Program and/or Refund form (TRS28) in
its entirety.
3. Section 4 – Refund Election. You must select one of the three options: Refund, Direct Rollover, or No
Refund.
4. Section 5 – Payment Method for Portion Not Being Rolled Over. You may select either Direct Deposit
or a paper treasury warrant. If you select Direct Deposit, be sure to include your financial institution
name, account type, bank routing number, account number, and complete the declaration.
5. Sign the form in the presence of a notary public in Section 6 – Member Certification and Signature.
6. Have your employer complete Section 7 – Employer Certification.
7. Send the completed form to TRS.
If you previously elected ORP participation but you did not withdraw your TRS accumulated contributions at
the time you elected ORP and you are now applying for a refund of your TRS accumulated contributions:
1. Read the Special Tax Notice Regarding Your Rollover Options Under TRS.
2. Complete Section 1 – Member Information on the Election to Participate in Optional Retirement
Program and/or Refund form (TRS28).
3. Do Not Complete Section 2 – Prior Optional Retirement Program Election Information.
4. Do Not Complete Section 3 – Member Election.
5. Complete Section 4 – Refund Election. You must select one of the three options: Refund, Direct
Rollover, or No Refund.
6. Complete Section 5 – Payment Method for Portion Not Being Rolled Over. You may select either
Direct Deposit or Check. If you select Direct Deposit, be sure to include your financial institution name,
account type, bank routing number, account number, and complete the declaration.
7. Sign the form in the presence of a notary public in Section 6 – Member Certification and Signature.
8. Do not have your employer complete Section 7 – Employer Certification.
9. Send the completed form to TRS.
1000 Red River Street
Austin, TX 78701-2698
(800) 223-8778
www.trs.texas.gov
Teacher Retirement System of Texas Page 4 of 4Teacher Retirement System of Texas Page 4 of 4
Information Sheet for Optional Retirement
TRS28IN (09-16)
Important Information
The form must be signed in front of a notary. If your name on the TRS28 is different than the one shown on TRS
records, you must send TRS a copy of the court order or marriage license documenting your name change or social
security card that reflects your name change. If your attorney-in-fact signs the request, a copy of the power of attorney
must be submitted for review.
Please note that in some cases, TRS will issue your refund payment as a paper treasury warrant even when you have
selected direct deposit. This may occur if the direct deposit information was not completed in its entirety. In addition, if
you elect direct deposit and indicate that 100% of the refund will be transferred out of the United States, you will not be
able to receive your refund through direct deposit and TRS will issue your refund payment as a paper treasury warrant
mailed to the address listed on your TRS28 form.
If you would like to roll over all or a portion of your accumulated contributions that are eligible for rollover, a Refund
Rollover Election form (TRS6A) must be submitted to our office. You must complete and sign the form TRS6A
indicating the amount that you wish to roll over. The representative of the retirement plan (plan administrator or trustee)
accepting the rollover must also sign the form certifying that the plan is eligible to receive the funds being rolled over
from your TRS account. Refer to the Special Tax Notice Regarding Your Rollover Options Under TRS included with the
Requesting a Refund packet for additional information as you consider whether to roll over your refund.
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Election to Participate in Optional Retirement Program andor (University of Texas System)

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