Fillable SERS Post Retirement Form

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SERS Post Retirement Form

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TEMPORARY POST RETIREMENT REEMPLOYMENT
State Employees Retirement System and Alternate
Retirement Program Retired Members Only
CO-1208 Revised 2/11
STATE OF CONNECTICUT
OFFICE OF THE STATE COMPTROLLER
RETIREMENT SERVICES DIVISION
GENERAL INFORMATION
Connecticut General Statutes (CGS) Section 5-164a, CGS Section 5-192v and the collective bargaining agreement between
the State and the State Employees Bargaining Agent Coalition effective July 1, 1997 (SEBAC V) address both the temporary
and permanent reemployment of retired State Employees Retirement System (SERS) and Alternate Retirement Program
(ARP) members.
Pursuant to these statutory provisions, temporarily reemployed SERS Tier I, Tier II, Tier IIA and ARP retirees may work a
maximum of 120 days (960 hours) in a calendar year without engaging the pension suspension provisions of SERS; a SERS
or ARP retiree reemployed in a state teaching position may work up to 45.97% of a full-time teaching schedule (12 load
credits) without engaging the pension suspension provisions of SERS.
Retired SERS or ARP members who are being permanently reemployed must complete a Form CO-931, " Designation of
Retirement System-Tier-Plan-Beneficiary".
NAME (Last, First, M.I.) (Print or Type) INCLUDE FORMER NAME
EMPLOYEE NUMBER
SOCIAL SECURITY NUMBER
RETIREE INFORMATION
ADDRESS (Street No.,Name)
Name)
(City, State, Zip Code)
RETIREMENT SYSTEM (Check one)
RETIREMENT DATE
SERS
ARP
DATE OF EMPLOYMENT
EMPLOYING AGENCY NAME
TEMPORARY EMPLOYMENT INFORMATION
CORE-CT DEPT. ID
EMPLOYING AGENCY ADDRESS
RETIREE STATEMENT
I understand that as a retired member of the State Employees Retirement System or the Alternate Retirement Program my
continued receipt of monthly retirement benefits is dependent upon my working 120 days or less or teaching no more than
45.97% of a full-time teaching schedule in a calendar year as a temporarily reemployed retiree. I further understand that I will
be subject to the pension suspension provisions of SERS should my employment exceed either of these maximums and may
be required to return over paid retirement income to the date of reemployment for that calendar year.
RETIREE SIGNATURE
DATE
TELEPHONE NUMBER
EMPLOYING AGENCY SIGNATURE ( designated human resources official )
TITLE
DATE
TELEPHONE NUMBER
Forward completed form to: Retirement Services Division, 55 Elm Street, Hartford, CT 06106
Agency should retain one copy and provide one copy to the temporarily reemployed retiree.
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SERS Post Retirement Form

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Completed 2 September 2020

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