Fill - Free fillable Notice Of Potential Benefits (Veterans Buy-back) Rev 2011 PDF form

The Notice of Potential Benefits Pursuant to G.L. c. 32, § 4(1)(h) notifies eligible veterans of their

rights to purchase creditable service for their military service. In order to purchase such service,

a member must meet the definition of "veteran" in G.L. c. 32, § 1. Keep in mind:

 If you have already been granted creditable service for active duty service under G.L. c.

32, §4(1)(h), you are no longer eligible to apply for that service

 You only have 180 days from the receipt of this notice to decide whether or not you wish

to purchase the creditable service for which you have applied.

 You should contact your retirement board for an estimate of the cost of this purchase

and payment options.

 Once purchased, a refund of the cost of this service is only available by a refund of all

accumulated deductions.

Introduction

Notice of Potential Benefits Pursuant to G.L. c. 32, §4(1)(h)

Form Last Revised: April 2011

COMMONWEALTH OF MASSACHUSETTS | PUBLIC EMPLOYEE RETIREMENT ADMINISTRATION COMMISSION

WEB | WWW.MASS.GOV/PERAC

 G.L. c. 32, § 4(1)(h) grants eligible honorably-discharged veterans the right to purchase up to four years to

add to their creditable service as a member of a retirement system due to service in the armed forces of

the United States.

State Veteran Status Eligibility

To be eligible for veterans' benefits, one must be a "veteran" or a dependent of a "veteran" under M.G.L. c. 4,

sec. 7, cl. 43rd as amended by the Acts of 2005, ch. 130. See below for service requirements and exceptions.

Notice of Potential Benefits Pursuant to G.L. c. 32, §4(1)(h)

Form Last Revised: April 2011

Retirement

Board: Please

place your address

and phone

number here. 

COMMONWEALTH OF MASSACHUSETTS | PUBLIC EMPLOYEE RETIREMENT ADMINISTRATION COMMISSION

WEB | WWW.MASS.GOV/PERAC

Era of Service Dates Requirement for Veteran Status

WWI 6-Apr-1917

11-Nov-1918

90 days of active duty service, one (1) day during "wartime" and a last dis-

charge or release under honorable conditions.

PEACETIME 12-Nov-1918

15-Sep-1940

180 days of regular active duty service and a last discharge or release under

honorable conditions.

WWII

(Merchant Marine:

7-Dec-1941 through

31-Dec-1946)

16-Sep-1940

25-Jul-1947

90 days of active duty service, one (1) day during "wartime" and a last dis-

charge or release under honorable conditions.

PEACETIME 26-Jul-1947

24-Jun-1950

180 days of regular active duty service and a last discharge or release under

honorable conditions.

KOREA 25-Jun-1950

31-Jan-1955

90 days of active duty service, one (1) day during "wartime" and a last dis-

charge or release under honorable conditions.

Korean Defense

Service Medal

28-Jul-1954

(to be deter-

mined later)

90 days of active duty service, last discharge under honorable conditions

and the Korean Defense Service Medal.

VIETNAM I 1-Feb-1955

4-Aug-1964

180 days of regular active duty service and a last discharge or release under

honorable conditions.

VIETNAM II 5-Aug-1964

7-May-1975

90 days of active duty service, one (1) day during "wartime" and a last dis-

charge or release under honorable conditions.

PEACETIME 8-May-1975

1-Aug-1990

180 days of regular active duty service and a last discharge or release under

honorable conditions.

Lebanon Campaign* 25-Aug-1982

(to be deter-

mined later)

90 days of active duty service, one (1) day during "wartime" and a last dis-

charge or release under honorable conditions.

Grenada Campaign* 25-Oct-1983

15-Dec-1983

90 days of active duty service, one (1) day during "wartime" and a last dis-

charge or release under honorable conditions.

(Chart continues on next page.)

Panama Campaign* 20-Dec-1989

31-Jan-1990

90 days of active duty service, one (1) day during "wartime" and a last dis-

charge or release under honorable conditions.

PERSIAN GULF 2-Aug-1990

(to be deter-

mined later)

90 days of active duty service, one (1) day during "wartime" and a

last discharge or release under honorable conditions.

Notice of Potential Benefits Pursuant to G.L. c. 32. §4(1)(h) 2

For GUARD MEMBERS to qualify they must have 180 days and have been activated under Title 10 of the

U.S. Code -OR- Members who were activated under Title 10 or Title 32 of the U.S. Code or Massachusetts

General Laws, chapter 33, sections 38, 40, and 41 must have 90 days, at least one of which was during war-

time, per the above chart.

For RESERVISTS to qualify, they must have been called to regular active duty, at which point their eligibility

can be determined by the above chart.

Training Duty Exception

Active duty service in the armed forces shall not include active duty for training in the Army or Air National

Guard or active duty for training as a Reservist in the Armed Forces of the United States.

Minimum Service Exception (for Death or Disability)

It is not necessary that an applicant have completed the minimum service for wartime or peacetime campaign

if he/she served some time in the campaign and was awarded the Purple Heart, or suffered a service-connect-

ed disability per the Discharge Certificate, or died in the service under honorable conditions.

Application

To the Retirement Board:

I respectfully request creditable service for my active service in the armed forces of the United States and

Active Reserve or National Guard under the provisions of G.L. c. 32, § 4(1)(h).

Name (Print) Social Security # Phone #

Address

Governmental Unit Date of Last Membership Date of Honorable Discharge

I sign this application under the pains and penalties of perjury. I affirm that the information presented in this

application is correct, complete and accurately presented. I understand that giving false or incomplete infor-

mation may subject me to the loss of my benefits as well as civil and criminal penalties.

Member’s Signature __________________________________ Date ________________

*Naval and Marine DD214 must indicate Expeditionary Medal. All DD214's must specify campaign: Lebanon,

Granada, or Panama.

Notice of Potential Benefits Pursuant to G.L. c. 32. §4(1)(h) 3

Procedures

You must complete this application and file it with your retirement board no later than 180 days

from the date you receive this notice. You must enclose a copy of your federal form DD214 with

your application.

 Payment of 10% of your salary when you last became a member of a retirement system per year of cred-

itable service being purchase is required. Consult your retirement board for payment options.

 Once your eligibility has been verified you will receive written notification of: (1) the years and months

of service you may purchase (not to exceed four years) and (2) the amount owed.

 No refunds are allowed after purchasing this service except by a refund of all accumulated deductions.

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