The Express Benefit Report form is used to report
accumulated unused sick leave balances and employment
termination information from each employer you performed
CalSTRS creditable service for during your final year of
employment.
This form must be completed and submitted even if
your unused sick leave balance at the time of retirement
is zero.
Each employer must report and certify required
employment termination information on this form to
comply with California law:
•
For retirements effective on or after January 1, 2013,
each of your employers during the last school year in
which you earned service credit can submit an Express
Benefit Report form if your unused sick leave was not
transferred between districts. Your last employer is
required to submit an Express Benefit Report form to
certify your employment termination and last day of
work, vacation or compensated approved leave.
•
For retirements effective before January 1, 2013, only
your last employer can report unused sick leave.
Your last employer is required to submit this form to
certify your employment termination and last day of
work, vacation or compensated approved leave.
Credit for unused sick leave is included in the calculation
of your retirement benefit. You must submit your Service
Retirement Application to CalSTRS before you’ll receive your
CalSTRS retirement benefit. If your employer submits the
Express Benefit Report form after you submit your retirement
application, it will not delay your initial benefit. Your full
benefit will be calculated when the Express Benefit Report
form is processed. You will receive a payment for any
accumulated difference.
An award letter with the updated information will be mailed
to you. Contact your employer if there are discrepancies
between your records and what your employer reported
to CalSTRS.
Members: Do not submit this form to CalSTRS. Instead,
each employer during your final year of employment
must submit a form after you complete section 1.
See Section 1: Member Information below for more
information.
SECTION 1: MEMBER INFORMATION
(TO BE COMPLETED BY MEMBER)
Enter all requested information.
Each employer you worked for during your final year
of employment must submit the Express Benefit Report
form. After you complete section 1, give the form and
instructions to your employer. Your employer must
complete sections 2–4, certify the information with their
signature, and return the form directly to CalSTRS.
If your retirement date is on or after January 1, 2013, and
you had multiple employers during the last school year of
CalSTRS-covered employment, mark the box indicating
this. Each employer will need a copy of this form.
SECTION 2: EMPLOYER INFORMATION
(TO BE COMPLETED ONLY BY EMPLOYERS)
County and District Codes: Enter the appropriate five-
digit county and district code. Example: Kern County,
Edison, would be 15-012. Contact your CalSTRS liaison if
you are unsure of your code.
Employer Contact Name, Address and Telephone: Enter
the name, mailing and email addresses, and phone and fax
numbers of the person CalSTRS should contact if there are
questions about information submitted on this form.
Last Date of Work, Vacation or Compensated Approved
Leave: Enter the date of the member’s last day of work,
vacation or compensated approved leave. If the member
was on a compensated approved leave or a leave of
absence, enter the date of the last actual day of that leave.
This date must be before the member’s retirement date.
Sick Leave Days
Unused Basic Sick Leave Days
Enter the number of accumulated unused sick leave days the
member will have as of the last day of paid employment.
Unused Excess Sick Leave Days
Enter the number of accumulated unused excess sick
leave days the member will have as of the last day of paid
employment. Excess sick leave is sick leave granted by the
employer after June 30, 1986, that exceeds one day of sick
leave per pay period of at least four weeks.
If you granted or accepted the transfer of unused excess
sick leave for the member, CalSTRS will bill you for the
present-value cost of the unused excess sick leave you
report. If we don’t receive your payment within 30 days,
we will recalculate the present-value cost to include interest
from the due date to the date full payment is received.
This applies only if you’re reporting unused excess sick
leave days.
Express Benefit Report—Information and Instructions
EXPRESS BENEFIT REPORT INFORMATION AND INSTRUCTIONS • REV 01/20 • PAGE 1 OF 2
