Fillable Florida Retirement System Pension Plan Application for Service (State of Florida / Dept. of management Services)

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Florida Retirement System Pension Plan Application for Service (State of Florida / Dept. of management Services)

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Florida Retirement System Pension Plan
Application for Service Retirement and the
Deferred Retirement Option Program (DROP)
PO BOX 9000 Tallahassee, FL 32315-9000
Local Phone: 850-907-6500 Toll Free: 844-377-1888 FAX: 850-410-2010
DP-11
Effective 09/18
Calculations
Rule 60S-11.002, F.A.C.
Instructional Page 1 of 1
All of the following are required before you can retire and become a DROP participant.
1. A properly completed Form DP-ELE, Notice of Election to Participate in the Deferred Retirement Option Program (DROP)
and Resignation of Employment (if you have not previously submitted one). If you are dually employed with one or more
Florida Retirement System (FRS) employer(s), each employer must complete the employer's portion of a Form DP-ELE
and Form DP-11.
2. A properly completed Application for Service Retirement and the DROP, Form DP-11. The DP-11 must be signed in the
presence of a notary public and approved by your employer. Since your DROP participation cannot be retroactive, you
should send the DP-11 to the Division of Retirement prior to the first day of the month your DROP will begin even if you do
not have the other required documents. The DP-11 will be accepted up to six months before your DROP participation date.
3. A properly completed Option Selection for Members, Form FRS-11o. An explanation of the options is on the attached page
titled "What Retirement Option Should You Choose."
4. A properly completed Spousal Acknowledgment Form, Form SA-1. You must complete and sign the top portion in the
presence of a notary. If you are married and select option 1 or 2, your spouse should complete the bottom portion in the
presence of a notary.
5. A check payable to the Florida Retirement System for any amount you owe, or a written statement that you do not wish to
claim the service. Please put your social security number on the face of the check. You may roll over funds from a
qualified plan (IRA, deferred compensation, etc.) to pay the amount due. Form PRO-1, Pretax Direct Rollover, must be
received with the payment.
6. Proof of your birth date. If you select Option 3 or 4, you must also submit birth date verification for your beneficiary. We
will accept legible photocopies of one of the following (except for i):
a. Copy of a birth certificate
b. Delayed birth certificate
c. Valid, unexpired U.S. passport
d. Census report more than 30 years old
e. Life Insurance policy more than 30 years
f. Letter from the Social Security Administration stating the date of birth it has established for the payment of benefits
g. Certificate of Naturalization
h. Florida driver's license issued after January 1, 2010 that indicates compliance with the federal REAL ID Act
i. In the absence of one of the above, a copy of two of the following documents:
(1) Birth certificate of child, showing age of parent (limit one)
(2) Baptismal certificate more than 30 years old
(3) Hospital record of birth
(4) School record at time of entering grammar school
7. A copy of your marriage certificate if you selected option 3 or 4 and name your spouse as your joint annuintant.
8. A final certification of your earnings by your employer for the last four months of your employment. Your employer is
aware of this requirement.
9. A Statement of Military Eligibility will be mailed to you if you claim military service and the form is needed.
10. A Beneficiary Designation, Form FST-12, if designating more than one beneficiary; otherwise complete the
Beneficiary Designation section of Form DP-11.
Florida Retirement System Pension Plan
Application for Service Retirement and the
Deferred Retirement Option Program (DROP)
PO BOX 9000 Tallahassee, FL 32315-9000
Local Phone: 850-907-6500 Toll Free: 844-377-1888 FAX: 850-410-2010
DP-11
Effective 09/18
Calculations
Rule 60S-11.002, F.A.C.
Page 1 of 1
DROP begin date: /01/ DROP termination and resignation date
I understand I must terminate all employment with FRS employers to receive a monthly retirement benefit and my DROP benefit
under Chapter 121, F. S. If I fail to terminate my employment in accordance with s. 121.021(39)(b), F.S., on my DROP termination
date, my retirement will be null and void and my FRS membership shall be established retroactively to the date I began DROP.
Termination requirements for elected officials are different as specified in s 121.091(13)(b)(4), F.S. Participation in the DROP does
not guarantee my employment for the DROP period. I cannot add service, change options, change my type of retirement or elect
the Investment Plan after the DROP begin date. I have read and understand the DROP Accrual Distribution information provided
with this form.
Member Signature: (sign in the presence of a Notary)
Notary: State of
, County of . The above named person who has sworn to and subscribed
before me this day of 20 and is personally known or has produced
as identification.
Signature of Notary Public
Print, Type or Stamp Commissioned Name of Notary Public
I have resigned my employment on the date stated below and elect to participate in the DROP in accordance with s. 121.091(13),
Florida Statutes (F.S.). My DROP participation cannot exceed a maximum of 60 months from the date I first reach my normal
retirement date as determined by the Division of Retirement.
Employer Certification: This is to certify that the above named member will be enrolled as a DROP Participant on the date stated
and will terminate his or her employment on the date stated.
For educational agencies only: I certify that the member's position of
meets the
definition of instructional personnel under Section 1012.01(2), Florida Statutes.
Authorized Personnel Signature: Agency Number:
Agency Phone: Date:
Beneficiary Designation: All previous beneficiary designations are null and void. To designate more than one primary
beneficiary, attach a Beneficiary Designation Form, FST-12.
Primary Contingent
Name Relation Name Relation
SSN DOB SSN DOB
Phone Phone
Address Address
Member Name Member SSN
Position Title Birth Date
Home Phone Work Phone
Home Mailing
Address
Present FRS
Employer(s)
Email
Resignation From Employment to Participate in the DROP:
I elect to participate in the DROP in accordance with s 121.091(13), Florida Statutes (F.S.), as indicated below, and resign my
employment on the date I terminate from the DROP. I understand that the earliest date my participation in the DROP can begin is
the first date I reach normal retirement date as determined by law and that my DROP participation cannot exceed a maximum of
60 months from the date I reach my normal retirement date, although I may elect to participate for less than 60 months.
Participation in the DROP does not guarantee my employment for the DROP period.
I understand that I must terminate all employment with FRS employers to receive a monthly retirement benefit and my DROP
benefit under Chapter 121. F. S. Termination requirements for elected officers are different as specified in s.121.091(13)(b)4., F. S.
I cannot add service, change options, change my type of retirement or elect the Investment Plan after my DROP begin date. I have
read and understand the DROP Accrual and Distribution information provided with this form.
DROP begin date: /01/ DROP termination and resignation date:
Member Signature: (sign in the presence of a Notary)
Notary: State of
, County of . The above named person who has sworn to and subscribed
before me this day of 20 and is personally known or has produced
as identification.
Signature of Notary Public
Print, Type or Stamp Commissioned Name of Notary Public
Employer Certification: This is to certify that the above named member will be enrolled as a DROP Participant on the date stated
and will terminate his or her employment on the date stated.
For educational agencies only: I certify that the member's position of
meets the
definition of instructional personnel under Section 1012.01(2) Florida Statutes.
Authorized Personnel Signature: Agency Number
Agency Phone: Date
Member Name Member SSN
Position Title Birth Date
Home Phone Work Phone
Home Mailing Present FRS
Address Employer(s)
Florida Retirement System Pension Plan
Notice of Election to Participate in the Deferred Retirement Option
Program (DROP) and Resignation of Employment
PO BOX 9000 Tallahassee, FL 32315-9000
Local Phone: 850-907-6500 Toll Free: 844-377-1888 FAX: 850-410-2010
DP-ELE
Effective 09/18
Calculations
Rule 60S-11.002, F.A.C.
Page 1 of 1
DROP Accrual Distribution Methods
When your participation in DROP begins, your DROP benefit is based on the option selected at retirement (begin date
for the DROP), and will accrue, with interest and cost-of-living adjustments, for the duration of your DROP
participation. Upon your termination of employment and DROP, you must elect one of the following methods of
payment for the DROP benefit within 60 days of your DROP employment termination.
1. Lump sum
All accrued DROP benefits, plus interest, less 20 percent tax remitted to the Internal Revenue Service (IRS),
shall be paid to the DROP participant or the surviving beneficiary.
2. Direct rollover
All accrued DROP benefits, plus interest, shall be paid from the DROP directly to the custodian of an eligible
retirement plan as defined in s. 402(c)(8)(B), Internal Revenue Code (IRC). However, in the case of an
eligible rollover distribution to the surviving spouse of a deceased participant, an eligible retirement plan is an
individual retirement account or annuity as described in s. 402(c)(9), IRC.
3. Partial lump sum
A portion of the accrued DROP benefits shall be paid to the DROP participant or surviving spouse, less IRS
tax, and the remaining DROP benefits shall be transferred directly to the custodian of an eligible retirement
plan as defined in s. 402(c)(8)(B), IRC. However, in the case of an eligible rollover distribution to the surviving
spouse of a deceased participant, an eligible retirement plan is an individual retirement account or annuity as
described in s. 402(c)(9), IRC. The proportions shall be specified by the DROP participant or surviving
spouse.
If you do not make an election of one of the above methods within the 60-day period, the Division of Retirement will
pay directly to you the accrued benefits in a lump sum, less IRS tax. If you fail to terminate in accordance with s.
121.021(39)(b), Florida Statutes (F.S.) on your DROP termination date, your retirement will be null and void and
your Florida Retirement System membership established retroactively to the date you began DROP.
Florida Retirement System Pension Plan
Application for Service Retirement and the
Deferred Retirement Option Program (DROP)
PO BOX 9000 Tallahassee, FL 32315-9000
Local Phone: 850-907-6500 Toll Free: 844-377-1888 FAX: 850-410-2010
Rule 60S-11.002, F.A.C.
Informational Page 1 of 1
Florida Retirement System Pension Plan
Option Selection for FRS Members
PO BOX 9000 Tallahassee, FL 32315-9000
Local Phone: 850-907-6500 Toll Free: 844-377-1888 FAX: 850-410-2010
FRS-11o
Effective 12/15
Calculations
Rule 60S-4.010, F.A.C.
Page 1 of 1
A member must select one of the following retirement options prior to receipt of their first monthly retirement benefit.
I select:
Option 1: A monthly benefit payable for my lifetime. Upon my death the monthly benefit will stop and my beneficiary
will receive only a refund of any contributions I have paid which are in excess of the amount I have received
in benefits. This option does not provide a continuing benefit to my beneficiary.
Option 2: A reduced monthly benefit payable for my lifetime. If I die within a period of ten years after my retirement
date, my designated beneficiary will receive a monthly benefit in the same amount as I was receiving for the
balance of the 10-year period. No further benefits are then payable.
Option 3: A reduced monthly benefit payable for my lifetime. Upon my death, my joint annuitant, if living, will receive
a lifetime monthly benefit payment in the same amount as I was receiving. (Exception: The benefit paid to a
joint annuitant under age 25, who is not your spouse, will be your option one benefit amount. The benefit will
stop when your joint annuitant reaches age 25, unless disabled and incapable of self-support, in which case
the benefit will continue for the duration of the disability.) No further benefits are payable after both my joint
annuitant and I are deceased.
The social security number of my joint annuitant is
.
Option 4: An adjusted monthly benefit payable to me while both my joint annuitant and I are living. Upon the death of
either my joint annuitant or me, the monthly benefit payable to the surviving person (my joint annuitant or
me) is reduced to two-thirds of the monthly benefit payable while we were both living. (Exception: The
benefit paid to a joint annuitant under age 25, who is not your spouse, will be your option one benefit
amount. The benefit will stop when your joint annuitant reaches age 25, unless disabled and incapable of
self-support, in which case the benefit will continue for the duration of the disability.) No further benefits are
payable after both my joint annuitant and I are deceased.
The social security number of my joint annuitant is
.
COMPLETE AND RETURN FORM SA-1
I understand I must terminate all employment with FRS employers to receive a retirement benefit under Chapter 121, Florida
Statutes. I also understand that I cannot add service, change options or change my type of retirement (Regular, Disability or Early)
once my retirement becomes final. My retirement becomes final when any benefit payment is cashed, deposited or when my
Deferred Retirement Option Program (DROP) participation begins.
Member Signature: (sign in the presence of a Notary)
Notary: State of Florida, County of
. The above named person who has sworn to and subscribed
before me this day of 20 and is personally known or has produced
as identification.
Signature of Notary Public
Print, Type or Stamp Commissioned Name of Notary Public
Member Name Member SSN
Florida Retirement System Pension Plan
Spousal Acknowledgment Form
PO BOX 9000 Tallahassee, FL 32315-9000
Local Phone: 850-907-6500 Toll Free: 844-377-1888 FAX: 850-410-2010
SA-1
Rev. 01/10
Calculations
Rule 60S-4.010, F.A.C.
Page 1 of 1
CHECK ONE OF THE FOLLOWING:
MARRIED:
YES NO IF YES AND YOU SELECTED OPTION 1 OR 2,
YOUR SPOUSE MUST ALSO COMPLETE BOX 2.
Notarized Signature of Member:
Notary: State of Florida, County of
. The above named person who has sworn to and
subscribed before me this day of 20 and is personally known or
produced as identification.
Signature of Notary Public - State of Florida
Print, Type or Stamp Commissioned Name of Notary Public
1
SPOUSAL ACKNOWLEDGMENT: I, being the spouse of the above named
member, acknowledge that the member has selected either Option 1 or 2.
Notarized Signature of Spouse:
Notary: State of Florida, County of
. The above named person who has sworn to and
subscribed before me this day of 20 and is personally known or
produced as identification.
Signature of Notary Public - State of Florida
Print, Type or Stamp Commissioned Name of Notary Public
The following is an explanation of all four Florida Retirement System Options:
Option 1: A monthly benefit payable for my lifetime. Upon my death, the monthly benefit will stop and my beneficiary will
receive only a refund of any contributions I have paid which are in excess of the amount I have received in benefits.
This option does not provide a continuing benefit to my beneficiary.
Option 2: A reduced monthly benefit payable for my lifetime. If I die within a period of ten years after my retirement date, my
designated beneficiary will receive a monthly benefit in the same amount as I was receiving for the balance of the
10-year period. No further benefits are then payable.
Option 3: A reduced monthly benefit payable for my lifetime. Upon my death, my joint annuitant, if living, will receive a lifetime
monthly benefit payable in the same amount as I was receiving. (Exception: The benefit paid to a joint annuitant
under age 25, who is not your spouse, will be your option one benefit amount. The benefit will stop when your joint
annuitant reaches age 25, unless disabled and incapable of self-support, in which case the benefit will continue for
the duration of the disability.) No further benefits are payable after both my joint annuitant and I are deceased.
Option 4: An adjusted monthly benefit payable to me while both my joint annuitant and I are living. Upon the death of either my
joint annuitant or me, the monthly benefit payable to the survivor is reduced to two-thirds of the monthly benefit
received when both were living. (Exception: The benefit paid to the joint annuitant under age 25, who is not your
spouse, will be your option one benefit amount. The benefit will stop when your joint annuitant reaches age 25,
unless disabled and incapable of self-support, in which case the benefit will continue for the duration of the
disability.) No further benefits are payable after both my joint annuitant and I are deceased.
2
Member Name: Member SSN:
FRS-TAR
FLORIDA RETIREMENT SYSTEM PENSION PLAN
TERMINATION AND REEMPLOYMENT AFTER RETIREMENT
Toll Free: 844-377-1888
Locally: 850-907-6500
Email: Retirement@dms.fl.gov
page 1 of 2
To begin receiving a retirement benefit, including the Deferred Retirement Option Program (DROP) payout, you must
terminate all employment relationships with all FRS-participating employers. If you are dually employed with one or more
FRS-participating employers, you must terminate from all positions, even if one of those positions is not an FRS-covered
position. You must terminate from all positions that include, but are not limited to:
• full time work
• part time work
• other personal services (OPS)
• election poll work
• substitute teaching
• adjunct instructing
• contractual services
• third-party companies providing services to FRS-participating employers
You are subject to the following termination requirement and reemployment restriction in the first 12 calendar
months from your service retirement effective date or following your DROP termination date:
TERMINATION REQUIREMENT: 1st through 6th calendar months
During the first six calendar months from your service retirement effective date or following your DROP termination
date, you cannot provide services (through paid or unpaid arrangements) in any capacity to an FRS-participating employer.
Providing services to an FRS-participating employer in any capacity during this six-calendar month period will cancel your
retirement and you and your FRS-participating employer will be held jointly and severally liable for repayment of all
retirement benefits received, which include any DROP accumulation or payout. This means that each party can be held
fully responsible for the repayment of the total amount of retirement benefits. There are no exceptions to the
six-calendar month termination requirement.
Examples of violations:
You terminate from all FRS-participating employment on June 10 and apply to begin receiving your monthly
retirement benefit in July. Your service retirement effective date is July 1, and your six-calendar month termination
requirement is from July through December. You become employed part-time with an FRS-participating employer
in September. This employment voids your retirement. Your retirement will be cancelled, and you and your
employer will be held jointly and severally liable for repayment of any retirement benefits paid to you during that
time.
You are dually employed with two FRS-participating employers and are in DROP. You work for your primary
employer in a regularly established position, and with your other employer as an adjunct, a non-reported position.
You terminate employment with your primary employer and exit DROP on August 31. You receive your DROP
payout and begin receiving your monthly retirement benefit in September. Your six-calendar month termination
requirement is from September through February. You never terminated your other position, an adjunct with an
FRS-participating employer. This employment voids your DROP. Your retirement will be cancelled, and you and
your employer will be held jointly and severally liable for repayment of any retirement benefits paid to you,
including your entire DROP payout.
FRS-TAR
FLORIDA RETIREMENT SYSTEM PENSION PLAN
TERMINATION AND REEMPLOYMENT AFTER RETIREMENT
Toll Free: 844-377-1888
Locally: 850-907-6500
Email: Retirement@dms.fl.gov
page 2 of 2
If you provide services to an FRS-participating employer during the 7
th
through 12
th
calendar months from your
service retirement effective date or following your DROP termination date, you must notify the division by
submitting a Form FR-23, Florida Retirement System Pension Plan Notification of Reemployment for Suspension
of Retirement Benefits. You can obtain this form from our website, frs.myflorida.com, or by contacting the division using
the information provided above.
Beginning with the 13
th
calendar month from your service retirement effective date or following your DROP termination date,
there are no restrictions on working for an FRS-participating employer.
If you retired under the disability provisions of the FRS and become employed with any employer, whether public or private,
your disability benefit will be discontinued. There are no reemployment exceptions for disability retirees.
For more information about the effects of reemployment on your retirement benefits, visit our website, frs.myflorida.com,
where you can view our “READY.SET.RETIRE.” guide that further explains the FRS reemployment provisions.
If you have any further questions about reemployment after retirement, you may contact the division using the information
provided above. When emailing the division, include your full name, the last four digits of your Social Security number, your
date of birth, and contact information.
REEMPLOYMENT RESTRICTION: 7th through 12th calendar months
During the 7
th
through 12
th
calendar months from your service retirement effective date or following your DROP
termination date, you may provide services to an FRS-participating employer if, and only if, you suspend your monthly
retirement benefits. If your benefits are not suspended, you and your employer will be held jointly and severally liable for
repayment of all retirement benefits received during the months in which you provided services. An exception to the
reemployment restriction is provided for retired law enforcement officers reemployed as school resource officers in
accordance with section 121.091(9)(f), Florida Statutes.
Example of a suspension of benefits:
You terminate from all FRS-participating employers on February 15 and apply to begin receiving your monthly
retirement benefit in March. Your service retirement effective date is March 1. Your 7
th
calendar month of
retirement is September and your 12
th
calendar month is February. You become reemployed with an
FRS-participating employer in October. You notify the division of your reemployment in October and the division
suspends your monthly retirement benefits from October through February. Your retirement benefits will resume
March.
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Florida Retirement System Pension Plan Application for Service (State of Florida Dept. of management Services)

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Completed 14 April 2021

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