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
PO BOX 9000 Tallahassee, FL 32315-9000
Local Phone: 850-907-6500 Toll Free: 844-377-1888 FAX: 850-410-2010
FR-11
Effective 09/18
Calculations
Rule 60S-4.0035, F.A.C.
Instructional Page 1 of 1
All of the following are required before your name can be added to the retired payroll.
1. Termination of all employment with all employers under the Florida Retirement System (FRS). If you are dually employed
with one or more FRS employer(s), you must terminate from all positions.
2. A properly completed Application for Service Retirement, Form FR-11. The FR-11 must be signed in the presence of a
notary public and approved by your employer. Since your retirement date will be determined by the date we receive the
FR-11, you should send the FR-11 to the Division of Retirement even if you do not have the other required documents.
The FR-11 will be accepted up to six months before your desired retirement date. Notify the division of any address or
telephone number changes that occur after you submit your FR-11.
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 indicated 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 FR-11.
11. Direct Deposit of your benefit is available through the state's Electronic Funds Transfer (EFT) program. An application will
be mailed to you after your name has been added to the retired payroll. If you are a state employee, currently on EFT, you
will automatically continue on EFT unless you cancel your authorization.
Florida Retirement System Pension Plan
Application for Service Retirement
PO BOX 9000 Tallahassee, FL 32315-9000
Local Phone: 850-907-6500 Toll Free: 844-377-1888 FAX: 850-410-2010
FR-11
Effective 09/18
Calculations
Rule 60S-4.0035, F.A.C.
Page 1 of 1
My services terminated, or will terminate, on . Your retirement date is determined by the
Division of Retirement.
I understand I must terminate all employment with FRS employers to receive a retirement benefit under Chapter 121, Florida
Statutes. This includes but is not limited to: part-time work, other personal services(OPS), substitute teaching, adjunct professor or
non-Division approved contractual services. I also understand that I cannot add service, change options, change my type of
retirement (Regular, Disability, and Early) or elect the Investment Plan once my retirement becomes final. My retirement becomes
final when any benefit payment is cashed or deposited.
Employer Certification: This is to certify that the above named member was employed by this agency and will terminate, or has
terminated on with the last day worked on .
Authorized Personnel Signature: Agency Number:
Agency Phone: 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
Beneficiary Designation: All previous beneficiary designations are null and void unless you are applying for a second career
retirement benefit. In the case of a second career benefit, this application does not affect your original benefit in any way. 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 Address
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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Completed 12 July 2021

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