Fillable Service Retirement Application Instructions (CalSTRS)

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Service Retirement Application Instructions (CalSTRS)

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  • 12 check-boxes
  • 196 other fields

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Service Retirement Application Instructions
This application is for Dened Benet members who are retiring from service. With your signature on page 8 of this
application, you certify that you have read the application instructions and the booklet, Your Retirement Guide, and are
applying for service retirement. NOTE: You must initial all corrections on your application. If you are married or in a
registered domestic partnership, your spouse or partner must also initial all corrections.
If you are applying for a disability benet, complete the Disability Benets Application—you may be eligible to receive a
service retirement benet while your application for disability benets is being evaluated. If you are a Cash Balance Benet
Program participant, complete the appropriate Cash Balance Benet application, available at CalSTRS.com/forms.
You may be able to complete and submit your application online using myCalSTRS for faster processing.
Step-by-step guidance is provided to ensure you complete your application correctly.
The following information supplements the instructions on
the Service Retirement Application.
SECTION 1—MEMBER INFORMATION
Include your mailing and email addresses, and home and
alternate telephone numbers, so we can contact you if we
have any questions. Be sure your name on your application
matches your name as it appears on your Social Security
card. If you know it, include your Client ID instead of your
Social Security number. You can find your Client ID on your
Retirement Progress Report.
SECTION 2—RETIREMENT INFORMATION
Retirement Date: You will be officially retired as of the
retirement date you put on your application, subject to the
following conditions:
1. The earliest date you can submit your application is six
months before your retirement date.
2. Your retirement date must be on or after January 1, 2012.
3. The earliest date you can retire is the day after your last
day of work, vacation or compensated approved leave,
whichever is later.
4. Your retirement date must be at least one day after your
most recent reinstatement if you previously received a
service retirement benefit.
5. If you are purchasing service credit, your retirement date
cannot be earlier than the date you complete payment of
your service credit purchase.
NOTE: If your retirement date is not the first day of the
month, your first benefit payment will be prorated for
that month.
Last Date of Work, Vacation or Compensated
Approved Leave:
Enter the last day of work, vacation or
compensated approved leave for which you were paid. This
date must be before your retirement date.
An Express Benefit Report form must be submitted to
verify your last date of work, vacation or compensated
approved leave.
Please contact CalSTRS in writing if your eligible highest final
compensation includes a period more than 15 years before
your last date of work, vacation or compensated approved
leave from your last CalSTRS-covered employer.
Mid-Year Retirement: The process of averaging for mid-
year retirees often results in a final compensation that is
lower than expected.
See the Your Retirement Guide booklet
at CalSTRS.com/publications to learn more.
Reduced Benefit Election: If electing the Reduced Benefit
Election, check the appropriate box and submit the Reduced
Benefit Election form. You must be at least age 55, but under
age 60, and have at least five years of service credit to apply
for retirement under this program. See the Your Retirement
Guide booklet for more information.
Other Public Retirement Systems: See the Your Retirement
Guide booklet and the Concurrent Retirement fact sheet at
CalSTRS.com/publications.
SECTION 3—YOUR DEFINED BENEFIT ELECTION
Section 3.1–Defined Benefit Election
Elect the Member-Only Benefit or the Modified Benefit.
If you are re-retiring within 12 months of your most recent
reinstatement date, you must keep the same benefit election.
If you previously elected the Member-Only Benefit, you must
keep the Member-Only Benefit; if you previously elected the
Modified Benefit, you must keep the Modified Benefit and the
same option and beneficiary. If you re-retire after 12 months
of reinstating, you may change or cancel your election before
or at retirement, but CalSTRS will apply a lifetime assessment
to your retirement benefit. The assessment may reduce your
retirement benefit for life. Once you have retired, you may
only make a postretirement option change under very limited
circumstances. See the Member Handbook to learn more.
Member-Only Benefit
The Member-Only Benefit provides you with a monthly
lifetime benefit, but it does not provide a monthly
lifetime benefit to anyone when you die. It is the highest
monthly benefit you can receive in retirement.
Modified Benefit
The Modified Benefit provides you with a modified monthly
lifetime benefit as well as a modified monthly lifetime benefit
for your option beneficiary after your death. Complete this
section if you are electing an option beneficiary or if you
elected an option beneficiary before retirement.
Your option beneficiary must be a living person or persons
or a special needs trust—it cannot be another type of trust,
charity, estate or other entity.
SR APPLICATION INSTRUCTIONS • REV 06/20 • PAGE 1 OF 9
Service Retirement Application Instructions continued
PAGE 2 OF 9 • REV 06/20 • SR APPLICATION INSTRUCTIONS
You will find descriptions of the options in the Your Retirement
Guide booklet. For an estimate of how each option would
affect your monthly retirement benefit, talk to a CalSTRS
benefits specialist, use the Retirement Benefits Calculator at
CalSTRS.com/calculators or complete the benefit estimate
worksheet in the Member Handbook.
The option and option beneficiary you elect on your
retirement application become effective on your retirement
date. To provide for someone or a special needs trust if you
should die before retirement, see the Member Handbook for
information on the Preretirement Election of an Option.
If you are electing an option due to a divorce or termination
of a domestic partnership, contact the Community Property
Section of the CalSTRS Office of General Counsel at
916-414-1725.
Beneficiary Information
Enter your option beneficiary information if you elect an
option other than the Compound Option. Include birth
date verification if your beneficiary isn’t a CalSTRS member.
Acceptable birth date verification documents include
a photocopy of a birth certificate, state-issued ID, U.S.
passport ID page or certain U.S. military IDs. If you elect the
Compound Option, complete your beneficiary information on
the Compound Option Election form and include the form with
your Service Retirement Application.
NOTE: If you wish to elect an option for the benefit of
a special needs trust, you must include the Certification
of a Special Needs Trust form (SR-1854), available at
CalSTRS.com/forms, with this application.
Your option beneficiary election is different from your one-
time death benefit recipient. To designate a recipient to receive
the death benefits payable in the event of your death, complete
the Recipient Designation form.
Section 3.2–Defined Benefit Tax
Withholding Preferences
Federal and California state laws require us to withhold
income tax on all benefit payments unless you specify
otherwise. (See “Additional Information on Tax Withholding
Preferences” on page 3 for more information, including state
tax withholding for nonresidents.)
If you do not complete this section or do not provide specifics
for the withholding rate, CalSTRS will withhold income
tax from all your monthly benefit payments according to
the established rate for a married individual claiming three
withholding allowances, unless you live outside California.
If you do not want taxes withheld, check the Do Not Withhold
boxes. Be aware that there are penalties for not paying
enough federal and state tax during the year, either through
withholding or estimated tax payments. See IRS Publication
505, Tax Withholding and Estimated Tax, at irs.gov. It explains
estimated tax requirements and describes penalties in detail.
You may be able to avoid quarterly estimated tax payments by
having enough withheld from your benefit payments. If you
want taxes withheld, mark the appropriate boxes and specify
the number of allowances. You may specify an additional dollar
amount to withhold for state and federal taxes. NOTE: For
California state income tax only, you may elect to withhold a
flat dollar amount without specifying allowances.
If you’re a nonresident of Califor
nia, your benefit is not subject
to California income tax. If you live outside of California but
are still considered a resident or domiciliary of California,
your benefit is subject to California income tax. We will
apply tax withholding based on the address you provide us.
If you live outside California but expect to have a California
tax liability, you may request that we withhold California
state tax from your payments in Section 3.2, “Defined Benefit
Tax Withholding Preferences.” If you’re unsure about your
California residency status, seek advice from a tax professional.
SECTION 4—YOUR DEFINED BENEFIT SUPPLEMENT
ELECTION
Section 4.1–Defined Benefit Supplement Election
If you made retirement contributions to CalSTRS on or
after January 1, 2001, you have a Defined Benefit
Supplement account.
Your Defined Benefit Supplement account balance is shown
on your Retirement Progress Report. If your account balance
is $3,500 or more on your benefit effective date, you can
choose to receive these funds as a lump-sum payment, an
annuity payment or a combination of a lump-sum and annuity
payment. If your account balance is less than $3,500, you
must take a lump-sum payment, which may be paid directly to
you or rolled over to a qualified plan such as Pension2, if the
balance is at least $200. See the Your Retirement Guide booklet
for more information.
If you choose to receive your funds as a lump-sum payment,
a period-certain annuity of three to nine years, or a
combination of the two, enter your payment instructions in
section 4.2. If you choose a lifetime or 10-year period-certain
annuity, skip to section 4.3.
Section 4.2–Defined Benefit Supplement
Payment Instructions
Lump Sum or Period-Certain Annuity of 3 to 9 Years
Complete this section if you choose a lump-sum payment or
period-certain annuity of three to nine years for your Defined
Benefit Supplement funds. If you choose an annuity payment
other than a period-certain annuity of three to nine years, you
do not need to complete this section.
If you would like your payment to be paid directly to you,
check the Direct Payment box. Your monthly annuity payments
will be mailed to the same address or transferred to the same
bank account as your retirement benefit.
Federal law allows lump-sum payments or period-certain
annuity payments of three to nine years to be rolled over into a
qualified plan. If you would like to roll over your payment to a
financial institution, check the Rollover box.
Be sure to read the Special Tax Notice: Your Rollover Options
on pages 5-9 of the Instructions.
Rollover of Tax-Deferred or After-Tax Contributions
and Interest
The amount of tax-deferred or after-tax contributions and
interest in your Defined Benefit Supplement account is shown
on your Retirement Progress Report. Your account balance
must be $200 or more to qualify for a rollover to a financial
institution. Enter the dollar amount or percentage (from 1% to
100%) that you would like to roll over.
For example: If you are going to receive a rollover-eligible
distribution of $4,000 and you choose to roll over 75 percent
of the distribution to a qualified IRA or an eligible plan,
CalSTRS will distribute $3,000 directly to the plan you specify.
The remaining 25 percent balance of $1,000 paid directly to
you is subject to 20 percent federal income tax withholding.
You will receive only $800 because $200 is withheld for
federal tax (or less, if you are a California resident and choose
to not opt out of state tax withholding).
Section 4.2.1–Rollovers to Pension2
Complete this section if you are doing a rollover to CalSTRS
Pension2. If you select Pension2 for your rollover, we will
obtain the required signatures on your behalf.
CalSTRS Pension2
®
Rollovers: If you select Pension2 for
your rollover, we will obtain the required signatures on your
behalf. If you already have a Pension2 account, we will roll
over your Defined Benefit Supplement funds to that account.
If you do not have a Pension2 account, we will open a
SR APPLICATION INSTRUCTIONS • REV 06/20 • PAGE 3 OF 9
Pension2 403(b) account for you and your investment will
be defaulted into Voya Fixed Plus III, a fixed investment
that guarantees your principal and a specific interest rate.
You can reallocate your investment at any time. For more
information or to enroll right now, visit Pension2.com or
call toll free 888-394-2060.
Section 4.2.2–Rollovers to Another Qualified Plan With
a Financial Institution If you are rolling over your Defined
Benefit Supplement funds to a financial institution other
than CalSTRS Pension2, you must get a signature from your
financial institution before submitting your application. In
addition, you will not be able to submit your application
online using myCalSTRS. You must submit a hard copy of
your application or fax it to CalSTRS.
When providing your financial institution information,
do not attach transfer documents or list “IRA” as the name
of your financial institution. We will mail your payment
to the financial institution address you provide, so it is
imperative that the financial institution name, address
and account number are correct. If the information is
incomplete, incorrect, not legible, or the financial institution
representative’s signature is not provided, your rollover
and retirement application will be delayed. We are not able
to process direct trustee-to-trustee transfers to financial
institutions outside the U.S.
ADDITIONAL INFORMATION ON TAX WITHHOLDING PREFERENCES Applies to Sections 3.2, 4.2 and 4.3
Service Retirement Application Instructions continued
Your tax withholding preferences will remain in effect until you
change or cancel them. Change or cancel your preferences using
the tax withholding feature on myCalSTRS or submit the Income
Tax Withholding Preference Certicate form, available at
CalSTRS.com/forms.
Withholding Choices: The number of state withholding allowances
you claim may be different from the number of allowances you
claim for federal withholding. To help determine the appropriate
number of allowances, see the following worksheets:
• State withholding certicate DE-4P at edd.ca.gov/
pdf_pub_ctr/de4p.pdf and
• Federal withholding certicate W-4P at irs.gov/
pub/irs-pdf/fw4p.pdf.
There may be penalties for not paying enough tax on your
benets during the year, either through withholding or estimated
tax payments.
Addresses Outside California: In compliance with federal law,
California does not tax the CalSTRS benets of nonresidents.
However, if you think you may be liable for California state income
tax, you may request CalSTRS to withhold state income tax. We do
not withhold income tax for states other than California.
Addresses Outside the U.S.: Federal law requires that federal
income tax be withheld from payments delivered outside the U.S.
or U.S. territories to U.S. citizens or non-U.S. resident aliens, as
well as payments made to U.S. resident aliens. U.S. citizens who
have payments delivered outside the U.S. or its territories and U.S.
resident aliens may elect any withholding status (married, single
or head of household) and zero or more withholding allowances.
Payments Delivered Outside the U.S. and to Foreign Persons: If
you’re a U.S. citizen and resident, non-U.S. resident alien or U.S.
resident alien, federal tax withholding is required on monthly
or lump-sum payments delivered to you outside the U.S. or its
possessions. You cannot waive federal income tax withholding in
this situation. See IRS Publication 505 at irs.gov for details.
U.S. citizens or resident aliens receiving payment while outside
the U.S. must provide CalSTRS a form W-9 in order to ensure
withholding is applied correctly. If you’re a nonresident alien,
nonresident alien beneciary or foreign estate, in the absence of
a tax treaty exemption, monthly or lump-sum payments generally
are subject to a 30 percent federal withholding tax on the taxable
portion of payments from U.S. sources. See IRS Publication 515,
Withholding of Tax on Nonresident Aliens and Foreign Entities, and
IRS Publication 519, U.S. Tax Guide for Aliens, at irs.gov.
If you’re a foreign person, submit Form W-8BEN, Certicate
of Foreign Status of Benecial Owner for United States Tax
Withholding, to CalSTRS before receiving any payments. The form is
available at irs.gov or by calling 800-829-3676.
For more information on tax liability, see IRS Publication 575,
Pension and Annuity Income, and the California Franchise Tax
Board Publication 1005, Pension and Annuity Guidelines, or
contact a qualied tax professional.
Service Retirement Application Instructions continued
PAGE 4 OF 9 • REV 06/20 • SR APPLICATION INSTRUCTIONS
Section 4.3–Defined Benefit Supplement Tax Withholding
Preferences
Direct Payment: Lump Sum or Period-Certain Annuity of
3 to 9 Years
If you choose to have payments paid directly to you, we must
withhold 20 percent for federal taxes.
CalSTRS will withhold 2 percent California state tax if your
address is in California unless you elect to not have state tax
withheld.
Lifetime Monthly Annuity or Period-Certain
Annuity of 10 years
If you elect to receive a Lifetime Monthly Annuity or a
Period-Certain Annuity of 10 years, you will need to specify
your tax withholding preferences. If you do not want taxes
withheld, mark the Do Not Withhold boxes. If you want taxes
withheld, mark the appropriate boxes and specify the number
of allowances. If you do not complete this section, we will
withhold income tax from your monthly payments according
to the established rate for a married individual claiming three
withholding allowances.
You may specify an additional dollar amount to withhold for
state and federal taxes. For California state tax only, you may
elect to withhold a flat dollar amount without specifying
allowances. California does not tax benefits of nonresidents.
See “Additional Tax Information” on page 3.
SECTION 5—REQUIRED SIGNATURES
Check all boxes that apply, then sign and date your Service
Retirement Application. If you are married or registered as a
domestic partner, your spouse or partner also must sign and
date your application. Your signature date is the date you
signed your application.
If your spouse or registered domestic partner does not sign
your application, you must include a signed Justification for
Non-Signature of Spouse or Registered Domestic Partner form,
available at CalSTRS.com/forms, with your application.
If you divorced or terminated a registered domestic
partnership and a portion of your CalSTRS benefit was
awarded to a former spouse or partner, check the box that
indicates this. You may need to refer to your settlement
agreement. If your court documents have not been reviewed
by CalSTRS, you may be asked to provide them. This can
delay the processing of your application.
In addition, if you provide inaccurate information regarding
your marital status, your application may be void.
SPECIAL TAX NOTICE: YOUR ROLLOVER OPTIONS
You are receiving this notice because a portion of your
CalSTRS payment is eligible to be rolled over to a qualified
IRA or an eligible employer plan. Read this notice to help you
decide whether to do a rollover.
SUBMITTING YOUR APPLICATION
Submit pages 1–8 of your Service Retirement Application by one
of the following methods. Keep a copy for your records.
myCalSTRS
Complete and submit your application online using
myCalSTRS for faster processing. Your spouse or registered
domestic partner will be directed to register for a myCalSTRS
account and submit an electronic signature.
Hand Delivery
Hand deliver your application to a local CalSTRS office
(see the Your Retirement Guide booklet or visit CalSTRS.com/
forms-drop).
Mail Your Application
CalSTRS
P.O. Box 15275, MS 65
Sacramento, CA 95851-0275
Overnight Delivery
If you are using a special mailing service such as UPS or
FedEx, send your application to:
CalSTRS
Member Services
100 Waterfront Place
West Sacramento, CA 95605
Fax Delivery
916-414-5965 or 916-414-5964
QUESTIONS
Email your questions using your myCalSTRS account or at
CalSTRS.com/contact, or call 800-228-5453.
RETIREMENT CHANGE REQUESTS
If you have already submitted your Service Retirement
Application and want to make a change or cancel your
retirement, CalSTRS must receive the Service Retirement
Application Change Request form no later than 30 days from the
date your first benefit payment is issued. This form is available
at CalSTRS.com/forms or by calling us. Use the form to change
or cancel your retirement date, option, option beneficiary,
Reduced Benefit Election or Defined Benefit Supplement
election, or to make other changes.
NAME OR ADDRESS CHANGE
Notify us immediately if you change your name or mailing
address. Update your contact information using your
myCalSTRS account or the Address Change Request form,
available at CalSTRS.com/forms or by calling us.
WORKING AFTER RETIREMENT
If you return to work after service retirement and perform
retired member activities in the California public school
system as an employee, an independent contractor or an
employee of a third party, you’re subject to restrictions under
state and federal law, including a separation-from-service
requirement and a postretirement earnings limit. For more
information, see the Working After Retirement fact sheet at
CalSTRS.com/publications.
Special Tax Notice: Your Rollover Options
INTRODUCTION
You are receiving this notice because all or a portion of
your CalSTRS Defined Benefit Supplement, Defined Benefit
refund or Cash Balance payment may be eligible for a
rollover to an IRA or another eligible employer plan. This
notice is intended to help you decide whether to do such
a rollover.
Rules that apply to most CalSTRS payments are described
in the “General Information About Rollovers” section. Special
rules that only apply in certain circumstances are described
in the “Special Rules and Options” section.
The following summarizes tax information and is provided
in accordance with Section 402(f) of the Internal Revenue
Code. CalSTRS does not provide tax information or advice.
Consult a tax professional, the Internal Revenue Service or
the State Franchise Tax Board for specific information and to
confirm that any relevant tax laws have not changed since
this notice was released.
Certain California tax information is also provided. In general,
California law conforms to federal tax law. However, there
are some differences between California and federal law. In
addition, if you do not meet California residency criteria, your
CalSTRS benefits are not subject to state income tax. For
additional information, visit ftb.ca.gov.
30-Day Notice Period and Your Right to Waive
Generally, CalSTRS cannot make a direct rollover or a
payment to you until at least 30 days after you receive this
notice. If you do not wish to wait until this 30-day notice
period ends before your payment is processed, you may
waive the notice period.
GENERAL INFORMATION ABOUT ROLLOVERS
How can a rollover affect my taxes?
You will be taxed on your CalSTRS payment if you do
not roll it over. If you are under age 59
1
/
2
and do not
do a rollover, you also will have to pay a 10 percent
additional federal income tax and a 2.5 percent additional
California state income tax on early distributions, unless an
exception applies.
If you do a rollover, however, you will not have to pay tax until
you receive distributions later and the 10 percent additional
federal income tax and 2.5 percent additional state income
tax will not apply if those distributions are made after you are
age 59
1
/
2
, or if an exception applies.
Where may I roll over my CalSTRS payment?
You may roll over the payment to either an IRA (an individual
retirement account or individual retirement annuity) or
another eligible employer plan (a tax-qualified plan, 403(b)
plan or 457(b) plan) that will accept the rollover. The rules
of the IRA or plan that holds the rollover will determine your
investment options, fees and rights to payment from the IRA
or employer plan. For example, no spousal consent rules
apply to IRAs and IRAs may not provide loans. Further, the
amount rolled over will become subject to the tax rules that
apply to the IRA or employer plan.
How do I do a rollover?
There are two ways to do a rollover. You can choose either a
direct rollover or a 60-day rollover.
Direct rollover: If you do a direct rollover, CalSTRS will
make the payment directly to your IRA or another eligible
employer plan. You should contact the IRA sponsor or the
administrator of the plan for information on how to do a
direct rollover.
If you do a direct rollover of only a portion of your CalSTRS
payment and a portion is paid to you at the same time, the
portion directly rolled over consists first of the amount that
would be taxable if not rolled over.
60-day rollover: If you do not do a direct rollover, you still
may do a rollover by making a deposit into an IRA or eligible
employer plan that will accept it. You will have 60 days after
you receive your CalSTRS payment to make the deposit.
If you do not do a direct rollover, CalSTRS is required
to withhold 20 percent of the payment for federal
income taxes. Unless you elect to not have state
tax withheld or you are a nonresident of California,
CalSTRS will withhold at 2 percent. This means that, in
order to roll over the entire payment in a 60-day rollover, you
must use other funds to make up for the 20 percent withheld
for federal taxes and any state tax withheld. If you do not roll
over the entire amount of the payment, the portion not rolled
over will be taxed in the year distributed and will be subject
to the 10 percent additional federal income tax and the 2.5
percent additional state income tax on early distributions if
you are under age 59
1
/
2
, unless an exception applies.
How much may I roll over?
If you wish to do a rollover, you may roll over all or part of the
amount eligible for rollover. Any CalSTRS payment is eligible
for rollover, except:
• Benefit payments spread over a period of at least 10 years
or over your life or life expectancy (or the lives or joint life
expectancy of you and your beneficiary).
• Required minimum distributions in the calendar year in
which you turn age 72 (age 70½ if you were born prior to
July 1, 1949) or after death.
• Corrective distributions of contributions that exceed tax
law limitations.
CalSTRS can tell you what portion of a payment is eligible
for rollover.
SR APPLICATION INSTRUCTIONS • REV 06/20 • PAGE 5 OF 9
If I don’t do a rollover, will I have to pay the 10 percent
additional federal income tax and the 2.5 percent
additional state income tax on early distributions?
If you are under age 59
1
/
2
, you will have to pay the 10 percent
additional federal income tax and 2.5 percent additional state
income tax on early distributions for any CalSTRS payment,
including amounts withheld for income tax, that you do not
roll over, unless one of the exceptions listed below applies.
This tax applies to the part of the distribution that you must
include in income and is in addition to the regular federal and
state income taxes on the payment not rolled over.
The 10 percent additional federal income tax and the
2.5 percent additional state income tax do not apply to the
following CalSTRS payments:
• Payments made after you separate from service if you will be
at least age 55 in the year of the separation.
• Payments that start after you separate from service if paid at
least annually in equal or close to equal amounts over your
life or life expectancy (or the lives or joint life expectancy of
you and your beneficiary).
• Payments made due to disability.
• Payments after your death.
• Corrective distributions of contributions that exceed
tax law limitations.
• Payments made directly to the government to satisfy
a federal tax levy.
• Payments made under a qualified domestic relations
order (QDRO).
• Payments up to the amount of your deductible medical
expenses whether or not you itemize deductions for the
taxable year.
• Payments for certain distributions related to certain federally
declared disasters.
• Certain coronavirus related distributions.
If I do a rollover to an IRA, will the 10 percent additional
federal income tax and the 2.5 percent additional state
income tax apply to early distributions from the IRA? If
you receive a payment from an IRA when you are under age
59
1
/
2
, you will have to pay the 10 percent additional federal
income tax and 2.5 percent additional state income tax on
the part of the distribution that you must include in income
unless an exception applies. In general, the exceptions to the
additional federal and state income taxes for early distributions
from an IRA are the same as the exceptions listed above
for early distributions from a plan. However, there are a few
differences for payments from an IRA, including:
• The exception for payments made after you separate
from service if you will be at least age 55 in the year of the
separation does not apply.
• The exception for qualified domestic relations orders does
not apply. However, a special rule applies under which,
as part of a divorce or separation agreement, a tax-free
transfer may be made directly to an IRA of a spouse or
former spouse.
• The exception for payments made at least annually in
equal or close to equal amounts over a specified period
applies without regard to whether you have had a
separation from service.
• There are additional exceptions for (1) payments for
qualified higher education expenses, (2) payments up to
$10,000 used in a qualified first-time home purchase,
and (3) payments for health insurance premiums after
you have received unemployment compensation for 12
consecutive weeks (or would have been eligible to receive
unemployment compensation but for self-employed status).
SPECIAL RULES AND OPTIONS
If Your Payment Includes After-Tax Contributions
After-tax contributions included in your payment are not
taxed upon distribution. If a payment is only part of your
benefit, an allocable portion of your after-tax contributions is
included in the payment, so you cannot take a payment of
only after-tax contributions. However, if you have pre-1987
after-tax contributions maintained in a separate account, a
special rule may apply to determine whether the after-tax
contributions are included in a payment. In addition, special
rules apply when you do a rollover, as described below.
You may roll over to an IRA a payment that includes after-
tax contributions through either a direct rollover or a 60-day
rollover. You must keep track of the aggregate amount of
the after-tax contributions in all of your IRAs (in order to
determine your taxable income for later payments from the
IRAs). If you do a direct rollover of only a portion of your
CalSTRS payment and the rest is paid to you, the portion
directly rolled over consists first of the amount that would
be taxable if not rolled over. For example, assume you
are receiving a distribution of $12,000, of which $2,000
is after-tax contributions. In this case, if you directly roll
over $10,000 to an IRA that is not a Roth IRA, no amount
is taxable because the $2,000 amount not directly rolled
over is treated as being after-tax contributions. If you do a
direct rollover of your entire CalSTRS payment to two or
more destinations at the same time, you can choose which
destination receives the after-tax contributions.
If you do a 60-day rollover to an IRA of only a portion of a
payment made to you, the after-tax contributions are treated
as rolled over last. For example, assume you are receiving
a distribution of $12,000, of which $2,000 is after-tax
contributions, and no part of the distribution is directly rolled
over. In this case, if you roll over $10,000 to an IRA that is
not a Roth IRA in a 60-day rollover, no amount is taxable
because the $2,000 amount not rolled over is treated as
being after-tax contributions.
PAGE 6 OF 9 • REV 06/20 • SR APPLICATION INSTRUCTIONS
Service Retirement Application Instructions continued
You may roll over to an eligible employer plan all of a
payment that includes after-tax contributions, but only
through a direct rollover—and only if the receiving plan
separately accounts for after-tax contributions and is not
a governmental section 457(b) plan. You can do a 60-day
rollover to an eligible employer plan of part of a CalSTRS
payment that includes after-tax contributions, but only up
to the amount of the payment that would be taxable if not
rolled over.
If You Miss the 60-Day Rollover Deadline
Generally, the 60-day rollover deadline cannot be extended.
However, the IRS has the limited authority to waive the
deadline under certain extraordinary circumstances, such
as when external events prevented you from completing the
rollover by the 60-day rollover deadline.
Under certain circumstances, you may claim eligibility for a
waiver of the 60-day rollover deadline by making a written
self-certification. Otherwise, to apply for a waiver from the
IRS, you must file a private letter ruling request with the
IRS. Private letter ruling requests require the payment of
a nonrefundable user fee. For more information, see IRS
Publication 590-A, Contributions to Individual Retirement
Arrangements.
If You Were Born On or Before January 1, 1936
If you were born on or before January 1, 1936, and receive a
lump-sum distribution that you do not roll over, special rules
for calculating the amount of the tax on the payment might
apply to you. For more information, see IRS Publication 575,
Pension and Annuity Income.
If You Roll Over Your Payment to a Roth IRA
If you roll over your CalSTRS payment to a Roth IRA, a
special rule applies under which the amount of the payment
rolled over (reduced by any after-tax amounts) will be taxed.
However, the 10 percent additional income tax and 2.5
percent additional state income tax on early distributions will
not apply (unless you take the amount rolled over out of the
Roth IRA within five years, counting from January 1 of the
year of the rollover).
If you roll over the payment to a Roth IRA, later payments
from the Roth IRA that are qualified distributions will not
be taxed, including earnings after the rollover. A qualified
distribution from a Roth IRA is a payment made after you are
age 59
1
/
2
—or after your death or disability, or as a qualified
first-time homebuyer distribution of up to $10,000—and
after you have had a Roth IRA for at least five years. In
applying this five-year rule, you count from January 1 of the
year for which your first contribution was made to a Roth
IRA. Payments from the Roth IRA that are not qualified
distributions will be taxed to the extent of earnings after the
rollover, including the 10 percent additional federal income
tax and 2.5 percent additional state income tax on early
distributions, unless an exception applies. Nonqualified Roth
IRA distributions are treated as coming first from after-tax
contributions. You do not have to take required minimum
distributions from a Roth IRA during your lifetime. For more
information, see IRS Publications 590-A, Contributions to
Individual Retirement Arrangements and 590-B, Distributions
From Individual Retirement Arrangements.
CalSTRS is not responsible for assuring your eligibility to
make a rollover to a Roth IRA. Consult your tax adviser if you
are interested in rolling over your payment to a Roth IRA.
If You Are Not a CalSTRS Member
Payments after a member’s death. If you receive a
distribution after a CalSTRS member’s death that you do not
roll over, the distribution will generally be taxed in the same
manner described elsewhere in this notice. However, the
10 percent additional federal income tax and 2.5 percent
additional state income tax on early distributions do not
apply. The special rule described under the section “If you
were born on or before January 1, 1936” applies only if the
CalSTRS member was born on or before January 1, 1936.
If you are a surviving spouse. If you receive a CalSTRS
payment as the surviving spouse of a deceased member,
you have the same rollover options that the member would
have had, as described elsewhere in this notice. In addition,
if you choose to do a rollover to an IRA, you may treat the
IRA as your own or as an inherited IRA.
An IRA you treat as your own is treated like any other IRA
of yours, so that payments made to you before you are age
59
1
/
2
will be subject to the 10 percent additional federal
income tax and 2.5 percent additional state income tax on
early distributions, unless an exception applies. In addition,
required minimum distributions from your Traditional IRA
don’t have to start until after you reach the age at which you
are subject to required minimum distributions. If you were
born prior to July 1, 1949, you were subject to required
minimum distributions beginning in the year you reached
age 70½. If you were born on or after July 1, 1949, you are
subject to required minimum distributions in the year you
reach age 72.
If you treat the IRA as an inherited IRA, payments from the
IRA will not be subject to the 10 percent additional federal
income tax and 2.5 percent additional state income tax
on early distributions. However, if the member had started
taking required minimum distributions, you will have to
receive required minimum distributions from the inherited
IRA. If the member had not started taking required minimum
distributions, you will not have to start receiving required
minimum distributions from the inherited IRA until the year
the member would have been age 72 (age 70½ if the
member was born before July 1, 1949).
SR APPLICATION INSTRUCTIONS • REV 06/20 • PAGE 7 OF 9
Service Retirement Application Instructions continued
If you are a surviving beneficiary other than a spouse.
If you receive a CalSTRS payment because of the member’s
death and you are a designated beneficiary other than a
surviving spouse, the only rollover option you have is to
do a direct rollover to an inherited IRA. Payments from the
inherited IRA will not be subject to the 10 percent additional
federal income tax and 2.5 percent additional state income
tax on early distributions. The entire balance of the inherited
IRA must be distributed by the end of the 10th calendar year
following the year of the member’s death, unless you are
an “eligible designated beneficiary.” An eligible designated
beneficiary is a beneficiary designated under the terms of
CalSTRS who is any of the following:
• The surviving spouse of the member.
• A child of the member who has not reached the age of
majority (18 in California and most other states).
• A chronically ill individual as defined in Internal Revenue
Code Section 401(a)(9)(E)(ii)(IV).
• Any other individual who is not more than 10 years
younger than the member.
Required minimum distributions to an eligible designated
beneficiary may be made over a period based on the
beneficiary’s life expectancy, beginning no later than the year
after the member’s year of death.
Different rules apply if the member died before
January 1, 2020. Consult your tax advisor and your IRA
provider about minimum required distributions.
Payments under a qualified domestic relations order.
If you are the spouse or former spouse of a CalSTRS
member who receives a payment from CalSTRS under a
qualified domestic relations order (QDRO), you generally
have the same options and the same tax treatment that
the member would have (for example, you may roll over the
payment to your own IRA or an eligible employer plan that
will accept it). However, payments under the QDRO will not
be subject to the 10 percent additional federal income tax or
2.5 percent additional state income tax on early distributions.
If You are a Nonresident Alien
If you are a nonresident alien and you do not do a direct
rollover to a U.S. IRA or a U.S. eligible employer plan,
CalSTRS is generally required to withhold 30 percent of the
payment for federal income taxes. If the amount withheld
exceeds the amount of tax you owe (as may happen if you
do a 60-day rollover), you may request an income tax refund
by filing IRS Form 1040NR and attaching your IRS Form
1042-S. See Form W-8BEN for claiming that you are entitled
to a reduced rate of withholding under an income tax treaty.
For more information, see also IRS Publication 519, U.S.
Tax Guide for Aliens, IRS Publication 515, Withholding of
Tax on Nonresident Aliens and Foreign Entities, and FTB
Publication 1100, Taxation of Nonresidents and Individuals
Who Change Residency.
OTHER SPECIAL RULES
If a payment is one in a series of payments for less than
10 years, your choice whether to make a direct rollover will
apply to all later payments in the series, unless you make a
different choice for later payments.
If your payments for the year are less than $200, CalSTRS
is not required to allow you to do a direct rollover and is not
required to withhold federal income taxes. However, you
may do a 60-day rollover.
When electing how to receive a CalSTRS payment that
is rollover eligible, any amount not designated for rollover
will be issued directly to you according to the payment
preference on file for your account.
You may have special rollover rights if you recently served
in the U.S. Armed Forces. For more information, see
IRS Publication 3, Armed Forces’ Tax Guide. You may
also have special rollover rights if you were affected by a
federally declared disaster or similar event, if you received a
distribution on account of a disaster, or if your distribution is
or was due to a qualified child birth or adoption. For more
information, visit irs.gov.
FOR MORE INFORMATION
See the Tax Considerations for Rollovers booklet at
CalSTRS.com. You should also consult a professional tax
adviser before taking a payment from CalSTRS.
In addition, you will find more information on the federal
tax treatment of payments from employer plans in IRS
Publications 575, Pension and Annuity Income, Publication
590-A, Contributions to Individual Retirement Arrangements,
590-B, Distributions From Individual Retirement
Arrangements, and Publication 571, Tax-Sheltered Annuity
Plans (403(b) Plans). These publications are available from
a local IRS office, at irs.gov, or by calling 800-TAX-FORM
(800-829-3676).
For information on state tax, contact the California
Franchise Tax Board at ftb.ca.gov or call 800-852-5711
(or 916-845-6500 if calling from outside the U.S.). Also see
FTB Publication 1005, Pension and Annuity Guidelines.
RIGHT TO RECEIVE PAPER DOCUMENT
Contact CalSTRS to receive this Special Tax Notice:
Your Rollover Options provided as a written paper document
at no charge.
RIGHT TO WITHDRAW YOUR CONSENT
You have the right to withdraw consent to receive electronic
delivery of the Special Tax Notice: Your Rollover Options at
any time. Withdrawal of your consent may delay processing
of your application. If you would like to withdraw your
PAGE 8 OF 9 • REV 06/20 • SR APPLICATION INSTRUCTIONS
Service Retirement Application Instructions continued
Service Retirement Application Instructions continued
consent to receive electronic delivery of the Special Tax
Notice: Your Rollover Options, contact CalSTRS and
request to receive this notice and application as a written
paper document at no charge.
Scope of Your Consent – Consent to receive electronic
delivery of the Special Tax Notice: Your Rollover Options
applies only to the particular transaction.
CalSTRS Contact Procedures – If you have questions
about the procedures for receiving a written paper docu-
ment or to update your electronic information, contact
CalSTRS at 800-228-5453, CalSTRS.com/contactus or
916-414-5040 (fax).
Software Requirements – The software requirements
needed to access and retain this Special Tax Notice:
Your Rollover Options follow:
• Internet Explorer, Version 7.0 and above
• Mozilla Firefox, Version 3.0 and above
• Apple Safari, Version 3.0 and above
• Google Chrome, Version 4.0 and above
Use Adobe
®
Reader
®
to view, print and save this notice and
other CalSTRS important online documents. If you do not
have Adobe Reader installed on your computer, you may
download the free program from the Adobe website.
CalSTRS is not responsible for any hardware or software
problems resulting from the installation of any third-party
tools, including Web browsers, programs or plug-ins listed.
Any third-party providers listed here are governed by their
own terms of use and privacy policies.
SR APPLICATION INSTRUCTIONS • REV 06/20 • PAGE 9 OF 9
This page intentionally left blank.
California State Teachers’ Retirement System
P.O.Box 15275, MS 65
Sacramento, CA 95851-0275
800-228-5453
CalSTRS.com
SR APPLICATION • REV 06/20 • PAGE 1 OF 8
Service Retirement
Application
SR0059 rev 06/20
For CalSTRS’ Ofcial Use Only
With my signature on page 8, I certify that I have read the instructions and the booklet, Your Retirement Guide,
and I am applying for service retirement.
Section 1: Member Information
Client ID Number
OR
Social Security Number
Last Name
First Name MI
Mailing Address Email Address
City State ZIP Code
Date of Birth (MM/DD/YYYY) Home Telephone Alternate Telephone
Section 2: Retirement Information
Retirement date (MM-DD-YYYY)
Your first benefit payment will be calculated from this date through the end of the month in which you retire.
Last date of work, vacation or compensated approved leave (MM-DD-YYYY)
This date must be before your retirement date.
I am electing retirement under the Reduced Benefit Election and have attached the Reduced Benefit Election
form to my retirement application.
( ) ( )
Other Public Retirement Systems
If you are a member of any of the following California public retirement systems and you did not perform service
between your CalSTRS retirement date and the other public system’s retirement date, you may be able to use the
other system’s final compensation for service that does not overlap. Mark all that apply and your retirement dates.
I am a member of the following California public retirement systems:
CalPERS SFERS LRS UCRS 1937 ACT COUNTY—County Name ___________________
My retirement dates from other systems are (MM/DD/YYYY) ______________________________________________
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PAGE 2 OF 8 • REV 06/20 • SR APPLICATION
Service Retirement Application continued
Name _____________________________________ Client ID or SSN _____________________
Section 3: Your Defined Benefit Election
Section 3.1 Defined Benefit Election
I have read the instructions that describe the Defined Benefit options available, and I elect the (choose only one):
Member-Only Benefit. (Skip to section 3.2.)
Modified Benefit. If you check this box, choose one below:
Modified Benefit
I previously submitted the Preretirement Election of an Option form or the Preretirement Compound
Option Election form. To confirm your original election, indicate the option you elected and your beneficiary:
(100%, 75%, 50% or Compound): .
Name of your option beneficiary or beneficiaries: .
OR
I am electing an option at retirement. (Your option beneficiary must be a living person or persons, or a special
needs trust, and cannot be another type of trust, estate, charity or other entity. This option is not the one-time death
benefit.) Choose one and complete the Beneficiary Information section below:
100% Beneficiary Option
75% Beneficiary Option
50% Beneficiary Option
Compound Option (If you choose the Compound Option, complete and attach the
Compound Option Election form.)
OPTION BENEFICIARY INFORMATION AT RETIREMENT
If you are electing a beneficiary option at retirement, enter your beneficiary information. If you are electing a special
needs trust, check the box, provide your beneficiary information below, and complete the Certification of a Special
Needs Trust form, available at CalSTRS.com/forms, and submit it with your Service Retirement Application.
I am electing a special needs trust.
Beneficiary’s Name (Last, First, Initial) Beneficiary’s Social Security Number or Tax ID
Mailing Address Email Address
City State ZIP Code
Home Telephone Alternate Telephone
Member of CalSTRS: Yes No
Gender: Male Female Nonbinary
Relationship: Spouse Registered Domestic Partner Other
Date of Birth (MM/DD/YYYY) ________________________________________________________________________
If your beneficiary is not a member of CalSTRS, you must attach birth date verification:
State–issued ID Birth Certificate U.S. passport ID page Other
( ) ( )
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SR APPLICATION • REV 06/20 • PAGE 3 OF 8
Service Retirement Application continued
Name _____________________________________ Client ID or SSN _____________________
Section 3.2 Defined Benefit Tax Withholding Preferences
If you do not complete this section or the information you provide is unclear, CalSTRS will withhold state and federal income
tax from your payment based on rates for a married person claiming three withholding allowances. (If you’re a nonresident
of California, you don’t have to pay state income tax. If you don’t live in California but think you may be liable for California
state income tax, you may request us to withhold state income tax below.)
Remember, there are penalties for not paying enough tax during the year, either through withholding or estimated tax
payments. You may be able to avoid paying quarterly estimated taxes by having enough state and federal tax withheld from
your monthly benefit payment.
You can update your tax withholding preferences online using your myCalSTRS account or the Income Tax Withholding
Preference Certificate form, available at CalSTRS.com/forms.
CALIFORNIA STATE INCOME
TAX WITHHOLDING
Do not withhold California state income tax.
OR
Withhold California state income tax.
Withhold only $ __________ from each benefit
payment. (Enter a flat dollar amount only. Do
not enter a percentage.)
OR
Withhold California state income tax based on
the tax tables for (choose one):
Married with __________
(Enter 0 or number of allowances.)
Single with __________
(Enter 0 or number of allowances.)
Head of household with __________
(Enter 0 or number of allowances.)
Additional withholding: $ __________
from each benefit payment in addition to the
amount to be withheld based on state tax
tables. (You cannot enter an amount without
selecting one of the above options. Enter a
dollar amount only.)
FEDERAL INCOME
TAX WITHHOLDING
Do not withhold federal income tax.
OR
Withhold federal income tax based on the tax
tables for (choose one):
Married with __________
(Enter 0 or number of allowances.)
Single with ____________
(Enter 0 or number of allowances.)
Additional withholding: $ __________
from each benefit payment in addition to the
amount to be withheld based on federal tax
tables. (You cannot enter an amount without
selecting one of the above options. Enter a
dollar amount only.)
NOTE: A flat amount cannot be withheld for
federal income tax, unless you also withhold
according to the federal tax tables.
If you do not complete this section or the information you
provide is unclear,
Clear Page 13
Name _____________________________________ Client ID or SSN _________________
Section 4: Your Defined Benefit Supplement Election
Section 4.1 Defined Benefit Supplement Election
If you made retirement contributions to CalSTRS on or after January 1, 2001, you have a Defined Benefit Supplement
account with CalSTRS. If your Defined Benefit Supplement account balance is:
• Under $3,500, you must take a lump-sum payment. Mark the lump-sum payment box below.
• $3,500 or more, you have choices about how to receive these funds.
Defined Benefit Supplement Choices
You have three payment choices for your Defined Benefit Supplement account. Choose only one.
1. Lump-Sum Payment You have three choices. Choose one:
Check paid to you directly. (Skip to section 4.2 and select Direct Payment.)
Rollover to CalSTRS Pension2. (Skip to section 4.2, select Rollover, then go to section 4.2.1.)
Rollover to another qualified plan with a financial institution. (Skip to section 4.2, select Rollover,
then go to section 4.2.2.)
2. Annuity Payment You have two choices. Choose one:
Period-Certain Monthly Annuity of 3 to 10 years*
Number of years (circle one) 3 4 5 6 7 8 9 10 Then select one:
Check paid to you directly. (Skip to section 4.2 and select Direct Payment.)
Rollover to CalSTRS Pension2. (Skip to section 4.2, select Rollover, then go to section 4.2.1.)
Rollover to another qualified plan with a financial institution. (Skip to section 4.2, select Rollover,
then go to section 4.2.2.)
OR Lifetime Monthly Annuity*
If you elected the Member-Only Benefit on page 2, you have one choice:
Member-Only Annuity
If you elected the Modified Benefit on page 2, you have three choices. Select one:
100% Beneficiary Annuity 75% Beneficiary Annuity 50% Beneficiary Annuity
3. Combination Lump Sum and Annuity After your lump-sum payment, at least $3,500 must remain in your Defined
Benefit Supplement account to fund an annuity. Indicate your lump-sum payment amount and select one annuity.
$______________ Lump-Sum Amount
Check paid to you directly. (Skip to section 4.2 and select Direct Payment.)
Rollover to CalSTRS Pension2. (Skip to section 4.2, select Rollover, then go to section 4.2.1.)
Rollover to another qualified plan with a financial institution. (Skip to section 4.2, select Rollover,
then go to section 4.2.2.)
Annuity Payment You have two choices. Choose one:
Period-Certain Monthly Annuity of 3 to 10 years*
Number of years (circle one) 3 4 5 6 7 8 9 10 Then select
one:
Check paid to you directly. (Skip to section 4.2 and select Direct Payment.)
Rollover to CalSTRS Pension2. (Skip to section 4.2, select Rollover, then go to section 4.2.1.)
Rollover to another qualified plan with a financial institution. (Skip to section 4.2, select Rollover,
then go to section 4.2.2.)
OR Lifetime Monthly Annuity*
If you elected the Member-Only Benefit on page 2, you have one choice:
Member-Only Annuity
If you elected the Modified Benefit on page 2, you have three choices. Select one:
100% Beneficiary Annuity 75% Beneficiary Annuity 50% Beneficiary Annuity
*The Lifetime Monthly Annuity and Period-Certain Annuity of 10 years are not eligible for a rollover.
See section 4.3 for tax withholding preferences.
PAGE 4 OF 8 • REV 06/20 • SR APPLICATION
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Service Retirement Application continued
Name _____________________________________ Client ID or SSN _________________
Section 4.2 Defined Benefit Supplement Payment Instructions
I have received and read the Special Tax Notice: Your Rollover Options on pages 5-9 of the Instructions. I understand
I have at least 30 days before distribution to consider the information provided in this notice and decide whether
to elect a direct rollover to another retirement plan or have the amount distributed to me. By submitting this
application, the 30-day waiting period has been met or I waive the 30-day period. Indicate below if you want to receive your
Defined Benefit Supplement distribution as a direct payment or a rollover. Select one:
Direct Payment: I choose to have my Defined Benefit Supplement distribution paid directly to me. (Skip to section 4.3.)
OR
Rollover: I choose to roll over all or part of my Defined Benefit Supplement distribution to a qualified plan with a financial
institution. I understand that only lump-sum payments and period-certain annuities of three to nine years are eligible for
a rollover. I have completed the information below. Note: Any amount not designated for rollover will be paid directly to
me. See section 4.3, Direct Payment and mark the appropriate box for your tax withholding preferences.
Section 4.2.1 Rollovers to Pension2 (Does Not Require a Financial Institution Signature)
Complete this section if your rollover is to CalSTRS Pension2.
I choose to roll over all or part of my Defined Benefit Supplement distribution to CalSTRS Pension2. Only lump-sum
payments and period-certain annuities of three to nine years are eligible for a rollover. Complete the information below. If
you already have a Pension2 account, we will roll over your Defined Benefit Supplement funds to that account. If you do
not have a Pension2 account, we will open a Pension2 403(b) account for you and your investment will be defaulted into
Voya Fixed Plus III, a fixed investment that guarantees your principal and a specific interest rate. You can reallocate your
investment at any time. To access your account, visit CalSTRS.com/Pension2 or call 888-394-2060.
Rollover of Tax-Deferred Contributions and Interest
I elect to roll over my tax-deferred contributions and interest to CalSTRS Pension2.
Select one: Amount to transfer $_________ OR Percentage to transfer___________(indicate 1%-100%)
Rollover of After-Tax Contributions
I elect to roll over my after-tax contributions to CalSTRS Pension2.
Select one: Amount to transfer $_________ OR Percentage to transfer___________(indicate 1%-100%)
Next: If you:
• Chose to roll over 100 percent of your Defined Benefit Supplement account to CalSTRS Pension2, skip to section 5.
• Chose to roll over less than 100 percent of your Defined Benefit Supplement account, go to section 4.3 to indicate
your tax withholding preferences.
CalSTRS Pension2 403(b) and 457(b) Plans
Pension2, CalSTRS’ voluntary defined contribution plan, offers 403(b), 457(b), Roth 403(b) and Roth 457(b) plans with
flexible investment choices and low costs:
• Investments selected and monitored by CalSTRS for every type of investor—an investment with a competitive guaranteed
rate of return, Easy Choice Portfolios that provide ready-made diversified portfolios, Core Investment Options to build
your own portfolio, including institutional class mutual funds with lower expense ratios than retail mutual funds, and a
Self-Directed Brokerage Account for experienced investors.
• Simple, low-cost and transparent costs—there are no commissions, no surrender charges, no front- or back-end
load fees.
• Services, planning tools and a team to help you succeed.
To learn more, go to Pension2.com, call toll free 888-394-2060 or email Pension2@CalSTRS.com.
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PAGE 6 OF 8 • REV 06/20 • SR APPLICATION
Service Retirement Application continued
Name _____________________________________ Client ID or SSN ________________
Section 4.2.2 Rollovers to Another Qualified Plan With a Financial Institution (Requires Your Financial
Institution’s Signature)
Complete this section if your rollover is to another qualified plan with a financial institution. If you roll over your
Defined Benefit Supplement funds to an institution other than CalSTRS Pension2, you must obtain original signatures from
your financial institution. If you’re rolling over funds to a qualified plan other than CalSTRS Pension2, you cannot submit your
application online using myCalSTRS. You must submit a hard copy of your application or fax it to CalSTRS.
Rollover of Tax-Deferred Contributions and Interest
I elect to roll over my tax-deferred contributions and interest to one of the plans below.
Select one: Amount to transfer $ OR Percentage to transfer (indicate 1%–100%)
Select one: Traditional, SEP or SIMPLE IRA Other eligible plan (403(b), 457(b), 401(k) or 401(a))
Roth account (taxable rollover)
Financial Institution Information (All information is required.)
Account Number Make Check Payable to (Full Name of Financial Institution)
Payment Mailing Address City State ZIP Code
Name of Financial Institution’s Representative Telephone
Certification: My signature below confirms the account number for the individual named at the top of this page. As a representative
of the financial institution or plan named above, I certify that this institution or plan agrees to accept the funds described above as a
direct trustee-to-trustee transfer from CalSTRS for deposit into a qualified IRA or other eligible plan as defined in the Internal Revenue
Code. I understand that my signature below authorizes the transfer of CalSTRS funds as indicated above.
Financial Institution Representative’s Signature Signature Date (MM/DD/YYYY)
Rollover of After-Tax Contributions
I elect to roll over my after-tax contributions to one of the plans listed below (not applicable for most accounts).
Select one:
Amount to transfer $ OR Percentage to transfer (indicate 1%–100%)
Select one: Traditional or SEP IRA Other eligible plan (403(b), 457(b), 401(k) or 401(a)) Roth account
Financial Institution Information (All information is required.)
Account Number Make Check Payable to (Full Name of Financial Institution)
Payment Mailing Address City State ZIP Code
Name of Financial Institution’s Representative Telephone
Certification: My signature below confirms the account number for the individual named at the top of this page. As a representative
of the financial institution or plan named above, I certify that this institution or plan agrees to accept the funds described above as a
direct trustee-to-trustee transfer from CalSTRS for deposit into a qualified IRA or other eligible plan as defined in the Internal Revenue
Code. I understand that my signature below authorizes the transfer of CalSTRS funds as indicated above.
Financial Institution Representative’s Signature Signature Date (MM/DD/YYYY)
( )
( )
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SR APPLICATION • REV 06/20 • PAGE 7 OF 8
Service Retirement Application continued
Name _____________________________________ Client ID or SSN _________________
Section 4.3 Defined Benefit Supplement Tax Withholding Preferences
When completing this section, remember that there are penalties for not paying enough tax during the year, either through
withholding or estimated tax payments. You may be able to avoid paying quarterly estimated taxes by having enough state
and federal tax withheld from your benefit payment. California does not tax benefits of nonresidents. If you don’t live in
California but think you may be liable for California state income tax, you may request us to withhold state income tax.
Direct Payment Lump Sum and Period-Certain Annuities of 3 to 9 Years
Federal law requires CalSTRS to withhold 20 percent federal income tax from all lump-sum payments and period-certain
annuities of three to nine years that are paid directly to you. CalSTRS will automatically withhold federal tax from your payment.
Under state law, you can choose not to have any state tax withholding. If you’re a California resident and you make no
election, we will withhold at 2 percent.
Withhold California state income tax?
Yes No
Lifetime Monthly Annuity and Period-Certain Annuity of 10 Years
If you do not provide specific instructions in the section below, CalSTRS will withhold state and federal income tax from
your payment based on rates for a married person claiming three withholding allowances. However, if you do not provide
specific instructions on state tax withholding and you provided a non-California address on your application, we will assume
you are not a California resident and so we will not withhold state income tax.
CALIFORNIA STATE INCOME
TAX WITHHOLDING
Do not withhold California state income tax.
OR
Withhold California state income tax.
Withhold only $ __________ from each
benefit payment. (Enter a flat dollar amount
only. Do not enter a percentage.)
OR
Withhold California state income tax based on
the tax tables for (choose one):
Married with _________
(Enter 0 or number of allowances.)
Single with ___________
(Enter 0 or number of allowances.)
Head of household with __________
(Enter 0 or number of allowances.)
Additional withholding: $ __________
from each benefit payment in addition to the amount
to be withheld based on state tax tables. (You cannot
enter an amount without selecting one of the above
options. Enter a dollar amount only.)
FEDERAL INCOME
TAX WITHHOLDING
Do not withhold federal income tax.
OR
Withhold federal income tax based on the tax
tables for (choose one):
Married with __________
(Enter 0 or number of allowances.)
Single with ___________
(Enter 0 or number of allowances.)
Additional withholding: $ __________
from each benefit payment in addition to the
amount to be withheld based on federal tax
tables. (You cannot enter an amount without
selecting one of the above options. Enter a
dollar amount only.)
NOTE: A flat amount cannot be withheld for
federal income tax, unless you also withhold
according to the federal tax tables.
Clear Page 17
Service Retirement Application continued
Name _____________________________________ Client ID or SSN ________________
PAGE 8 OF 8 • REV 06/20 • SR APPLICATION
Section 5: Required Signatures
Check all that apply to your current and previous marital status. (You may check more than one.)
I am married or registered as a domestic partner and both our signatures are below.
I am married or registered as a domestic partner and my spouse or registered domestic partner did not
sign below. I have completed, signed and attached the Justification for Non-Signature of Spouse or
Registered Domestic Partner form.
I have never been married or in a registered domestic partnership OR
I am widowed or my registered domestic partner has died.
I have been divorced or have terminated a registered domestic partnership and my former spouse or
registered domestic partner was awarded a portion of my CalSTRS benefits.
I have been divorced or have terminated a registered domestic partnership and my former spouse or
registered domestic partner was not awarded a portion of my CalSTRS benefits.
Required Signatures
I certify that I have read the Service Retirement Application Instructions and the booklet, Your Retirement Guide, and I am applying
for service retirement. I fully understand that if my properly completed, signed and dated retirement application is approved by
CalSTRS and verified by my employer, I will be officially retired as of my requested retirement date.
I waive my right to the 30-day notice period for a Defined Benefit Supplement distribution direct payment or rollover (section 4.2).
I understand the 180 calendar day separation-from-service requirement, the annual earnings limit and the consequences of both,
if I return to work after retirement and perform retired member activities.
I understand it is a crime to fail to disclose a material fact or to make any knowingly false material statement, including a false
statement regarding my marital status, for the purpose of using it, or allowing it to be used, to obtain, receive, continue, increase,
deny or reduce any benefit administered by CalSTRS and it may result in penalties, including restitution, of up to one year in jail
and/or a fine of up to $5,000 (Education Code section 22010). It may also result in any document containing such false
representation being voided.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. I understand that
perjury is punishable by imprisonment for up to four years (Penal Code section 126).
Member’s Signature Signature Date (MM/DD/YYYY)
Current Spouse’s or Registered Domestic Partner’s Signature Signature Date (MM/DD/YYYY)
NOTE: Signature dates can be no earlier than six months before your requested retirement date.
Submitting Your Application
myCalSTRS
Complete and submit your application
online using myCalSTRS.
Hand Delivery
Hand deliver to a local CalSTRS office.
Find one at CalSTRS.com/forms-drop.
Fax Delivery
916-414-5964 or
916-414-5965
Mail Your Application
CalSTRS
P.O. Box 15275, MS 65
Sacramento, CA 95851-0275
Overnight Delivery
If you are using a special mailing service such
as UPS or FedEx, send your application to:
CalSTRS
Member Services
100 Waterfront Place
West Sacramento, CA 95605
Submit pages 1–8 of the Service Retirement Application. Keep a copy for your records. If you fax your application,
keep the confirmation page. We are unable to call and confirm receipt of your faxed application.
Clear Page 18
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Service Retirement Application Instructions (CalSTRS)

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Completed 20 June 2022

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