Fill - Free fillable Substitute, temporary or part-time public school service in (Commonwealth of Massachusetts) PDF form

M A I N O F F I C E

500 Rutherford Avenue, Suite 210

Charlestown, MA 02129-1628

Phone 617-679-MTRS (6877)

Fax 617-679-1661

W E S T E R N

R E G I O N A L O F F I C E

One Monarch Place

Springfield, MA 01144-2048

Phone 413-784-1711

Fax 413-784-1707

O N L I N E

mass.gov/mtrs

I N S T R U C T I O N S

You may be eligible to purchase credit for your prior service under certain job titles,

including but not limited to:

Please  these instructions  before completing the application.

Step 1: Determine your eligibility

 At the time of your application to purchase service, will you

be a “member in service” of the MTRS? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .





In general, a “member in service” is someone who is: actively teaching;

receiving Worker’s Compensation for total incapacity; on a sick leave; on

a paid leave; or, on an authorized unpaid leave of less than one year. If

you have any questions about whether you are a “member in service,”

please contact us.

If “yes,” please go to question 2. If “no,” you are ineligible to purchase

this service at this time; you must be a “member in service” at the time of

application in order to be eligible to purchase this creditable service.

2) Were you employed under one of the titles listed above in a

Massachusetts public school or in any collaborative on a

substitute, temporary or part-time basis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .





If “yes,” please go to Question 3. If “no,” your service may still be eligible

for purchase, but you need to apply using a different form—our Other MA

public service purchase application.

3) During your employment, were you a member of a Massachusetts

contributory retirement system? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .





If “no,” you may be eligible to purchase credit for your prior service.

Please go to Step 2.

If “yes,” and:

n you left your funds on account with that system, please call us and let us know. We

will review our records to determine if your prior service has already been credited

with us; if it has, we will let you know, and if not, we will contact that system and

request a transfer of your account.

n you took a refund of your account from that system, you may be eligible to receive

credit by “buying back” your refund. To initiate this process, please complete our

Prior refunded service with a Massachusetts contributory retirement system application.

Form SubTemp-03012018

IMPORTANT R E M I N D E R S : From the time that you begin to gather your required

documentation to the time that we send you an invoice, the service purchase process can take

several months. If you are approaching retirement and you wish to purchase this service, you

should be sure to complete and return your application at least six months before your date of

retirement, so please plan ahead. As a reminder, service cannot be purchased after the effective

date of your retirement.

Have questions or need assistance? Please don’t hesitate to contact our main office at

617-679-6877. We’re here to help!

M A S S A C H U S E T T S T E A C H E R S ’ R E T I R E M E N T S Y S T E M

Instructions and application for purchasing

Substitute, temporary or part-time

public school service in Massachusetts

n Tutor

n Teaching Assistant

n Teacher’s Aide

n Paraprofessional

n Daily Sub

n Long-term Sub

image courtesy of John Phelan,

Wikimedia Commons

REMINDER: This application is in interactive pdf format, which means that you can enter data in the fields, but

you CANNOT SAVE the form with your entered data. Accordingly, if you enter data onscreen, please print and

proofread your form BEFORE you close the document.

Reset all fields

Step 2: Review these Q&A to understand

the restrictions and application process

 

 

Yes—you may purchase credit for your Massachusetts substitute,

temporary or part-time public school teaching or tutoring service,

subject to the following restrictions:

n Service rendered as an “independent contractor” is 

eligible for purchase.

n All service that is considered “non-membership” service will

be credited on a proportional basis. In other words, if you

worked in a 40 percent position, you will receive 40 percent

credit upon payment for the service. “Non-membership”

service is all service that did not require membership in the

MTRS.

n Credit for day-to-day substitute service is based on the

number of full days worked, divided by 180 (the number of

days in a standard school year).

n If the service rendered was on a day-to-day basis after July 1,

2009, and you earned less than $5,000 annually, then this

service may be ineligible for purchase.

 

 

 

Depending on how much creditable service you will have at the

time of retirement, purchasing your Massachusetts substitute,

temporary or part-time public school service credit may or may

not make financial sense for you. Please be aware that a retirement

allowance can be no higher than 80 percent of your allowable final

salary average, and a service purchase, once made, cannot be

refunded. So, before you decide to purchase this service, or decide

how much to purchase, please consider whether you expect to be

at or near the 80 percent maximum at the time of your retirement

without this purchase.

To compare your retirement benefits both with and without this

service purchase, visit our website at mass.gov/mtrs and use our

online estimator.

Step 3: Apply to purchase this service

If you have read and understand the Q&A in Step 2, and

believe that you are eligible to apply to purchase credit for

your substitute, temporary or part-time service, please:

1)  Section 1 of the application form.

2) Contact the payroll or business office of your prior

Massachusetts public school district and explain that, for

purposes of potentially purchasing your prior service credit,

you need documentation of your service, and that you would

like to have a representative complete a portion of your

application. Ask this person to complete Sections 2-4 and then

return the form to you.

If you are applying to purchase substitute, temporary or

part-time service that you rendered in more than one school

district, please be sure to complete separate forms for each

school district.

3) a copy of your completed application for your records.

4)  your completed  application pages to either our

main or Western Regional office (addresses on form). Please

note that your application will not be accepted unless

 sections are complete; if any required sections are not

complete, your form will be returned to you for completion.

After we receive your completed application, we will review it,

determine your eligibility to purchase the service, and, if eligible,

send you an invoice. Along with your invoice, you will receive

information regarding how you may pay for your purchase.

Instructions and application for purchasing MAS S A CHUS E T TS T EACH E R S’ RE TIR E M ENT SYSTE M

Substitute, temporary or part-time public school service in Massachusetts Page ii

Form SubTemp-03012018

The cost of purchasing your past service is based on what you

would have paid in retirement contributions to the MTRS

during the period of your employment—either at the

contribution rate that would have been in effect or at your

contribution rate, if you were a member of the MTRS prior to

rendering your substitute, temporary or part-time service and

you left your funds on account with us—plus interest*, at the

actuarial interest rate in effect at the time of your application.

EXAMPLE

If you were a long-term substitute teacher from January 2002 to

June 2003, a period of 108 days, and you were paid $10,800, your

cost to purchase that period of service would be $1,188, plus

actuarial interest from January 2002 to the date of your purchase.

Amount paid for service $ 10,800

x Contribution rate of 11% x 0.11

Contributions to MTRS for period $ 1,188

+ Actuarial interest from January 2002

to date of purchase + Interest

Total purchase cost Total cost

CONTRIBUTION RATE TABLE

If your service was rendered… The contribution

rate applied is…

Before January 1, 1975 5%

January 1, 1975 through December 31, 1978 7%

January 1, 1979 through December 31, 1983 7% + 2% on

earnings over $30,000

January 1, 1984 through June 30, 1996 8% + 2% on

earnings over $30,000

July 1, 1996 through June 30, 2001 9% + 2% on

earnings over $30,000

July 1, 2001 or after 11%

*EXCEPTION: If you established membership in a

Massachusetts public retirement system on or after April 2,

2012, and you had previously been a member of a

Massachusetts public retirement system and taken a refund of

your account, you will have one year from the date that you

re-entered public service to apply and pay for your service

purchase at the lower “buyback” interest rate in effect at the

time of your application. After your first year of re-entry to

membership, you will be subject to actuarial interest.

How is the cost of my service

purchase calculated?

S E C T I O N 1

APPLICANT DATA

AND SIGNATURE

Instructions to applicant:

Please provide your

personal data and then

forward these three

pages to the payroll

official of the

Massachusetts

school district in which

you rendered your prior

service for completion of

Sections 2-4.

The payroll officer will

then return these

completed pages to you,

and you are responsible

for forwarding the

completed application to

the MTRS in order to apply

to purchase this service.

M A I N O F F I C E

500 Rutherford Ave., Suite 210, Charlestown, MA 02129

n 617-679-MTRS (6877) n Fax 617-679-1661

W E S T E R N R E G I O N A L O F F I C E One Monarch Place, Springfield, MA 01144 n 413-784-1711 n Fax 413-784-1707

Service credit purchase application

Substitute, temporary or part-time public school

service in Massachusetts

Form SubTemp-03012018

ST OP

Sections 2-4 must be completed by a payroll official of the school

district where this service was rendered (named in line i above).

a) Name of applicant . . . . . . . . . . . . . . . . . . . .

b) MTRS member number, if known. . . . . . . . . Not known

c) Social Security number. . . . . . .

XXX-XX-XXXX

d) Former/maiden name, if applicable . . . . . . . Not applicable

e) Mailing address . . . . . . . . .

Number and street

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . City State ZIP

f) Phone number . . . . . . . . . . . . . . . . . . . . . . .

Home Cell

Work

g) E-mail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h) Are you currently employed by a

Massachusetts school district? . . . . . . . . . . .

No Yes. If “yes”:

Name of current employer . . . . . . . . . . . . . . .

Current MTRS employment status .

Check one

Active On an authorized leave of absence

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . for not more than one year

i) MA school district in which past

service was rendered . . . . . . . . . . . . . . . . . .

j) Period of service . . . . . . . . . . . .

mm/dd/yyyy

From

Your position title

at that time

(e.g., teacher) . . . . . . . . . . . . . . .

I, the above-named member of the Massachusetts Teachers' Retirement System, hereby apply to purchase credit for my

prior service, subject to my eligibility to do so. I understand that if I wish to purchase this service, I must: apply for this

service purchase while I am a member in service (either an active member of the MTRS or an inactive member on an

authorized leave of absence for not more than one year); have Part 2 of this application completed by a representative

from my prior school district, and submit Parts 1 and 2 together to the MTRS at the same time; and, pay the total amount

due before my date of retirement from the MTRS. I certify under the penalties of perjury that the information I have

provided is true and accurate.

Signature Date

For our processing purposes, please answer the following questions:

Are you also applying to purchase substitute, temporary or part-time

public school service rendered in any other Massachusetts school districts? . . . . . .

No Yes

When do you plan to retire? . . . . . . . . . . . .

1-6 mos. 7-12 mos. 1-2 years 2+ years

SEC T I ON 3

SERVICE AND

SALARY

INFORMATION

Complete the

checklist in this section,

then indicate the service

rendered using the

applicable table(s). If you

have any questions about

completing this form,

please contact the MTRS

at 617-679-6877.

SEC T I ON 2

EMPLOYMENT

INFORMATION

Massachusetts Teachers’ Retirement System: Service credit purchase application Applicant’s name

Substitute, temporary or part-time public school service in Massachusetts

MTRS member number

page 2 of 3

During any periods of the applicant’s public school service...

a) Was he or she employed on at least a half-time basis (50% or above)? . . . . Yes No

b) Was he or she certified by the Massachusetts Department

of Elementary and Secondary Education or the Board of

Allied Health Professionals?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

c) Did he or she hold a position that required certification by the

Massachusetts Department of Elementary and Secondary Education

or the Board of Allied Health Professionals? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

d) Was he or she covered by a contractual agreement

for his or her period of employment?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If documenting service as a long-term substitute,

Documentation

please attach a copy of the appointment/hire/offer letter . . . . . . . . . . . . . .

attached

If you answered “Yes” to all of the questions above, this may indicate that deductions were omitted in error. Please indicate the applicable

service information below.

SERVICE D U R I N G W H I C H THE A P P L I C A N T M A Y HAVE B E E N E L I G I B L E FOR M T R S M E M B E R S H I P

Period during which

service was rendered

From To

Member’s position title Number

of days in

contract

Number

of days

paid

Employment

Status

% of full-time

Annual contract

rate

Actual gross

amount paid

a) During any period of the applicant’s substitute,

temporary or part-time service, did he or she

contribute to any Massachusetts

contributory retirement system? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If “yes,” please identify the system . . . . . . . .

b) What was the applicant’s

employment status during

this service? . . . . . . . . . . . . . . Employee Consultant/Vendor Independent Contractor

Other

Form SubTemp-03012018

If you answered ”No” to any of the questions above, please indicate service rendered on an annual basis below. If service was rendered on

a daily or hourly basis, please go to the next page.

SERVICE R E N D E R E D O N AN A N N U A L B A S I S

Period during which

service was rendered

From To

Member’s position title Number

of days in

contract

Number

of days

paid

Employment

Status

% of full-time

Annual contract

rate

Actual gross

amount paid

Please use this section to report the applicant’s service with your school rendered on a daily or hourly basis. Please list the service in

chronological order, beginning with the oldest service and ending with the most recent service.

SERVICE R E N D E R E D O N A D A I L Y O R HOURLY B A S I S

Month/year in which Member’s position title Number of Daily Number of Hourly Actual gross

service was rendered DAYS worked rate

HOURS worked

rate amount paid

If necessary, please list additional service on the following page and check this box. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SEC T I ON 3

(continued)

I certify that the information I have provided above is true and accurate.

Signature of payroll

department official. . . Date

Name (please print) .

Title . . . . . . . . . . . . .

School district . . . . .

Address . . . . . . . . . .

City Zip

Phone . . . . . . . . . . .

Fax. . . . . . . . . . . . . .

E-mail. . . . . . . . . . . .

/ /

SEC T I ON 4

STATEMENT AND

SIGNATURE OF

SCHOOL

DISTRICT

PAYROLL

OFFICIAL

Form SubTemp-03012018

REMINDER: Please return

these three ORIGINAL pages

directly to the applicant,

not the MTRS.

Thank you!

Massachusetts Teachers’ Retirement System: Service credit purchase application Applicant’s name

Substitute, temporary or part-time public school service in Massachusetts

MTRS member number

page 3 of 3

SEC T I ON 3

SER V I CE AND S A L ARY IN F O RMATI O N

(continued, if necessary)

Form SubTemp-03012018

.OptionalAdditionalSheetSec3

SERVICE R E N D E R E D O N A D A I L Y O R HOURLY B A S I S

Month/year in which Member’s position title Number of Daily Number of Hourly Actual gross

service was rendered DAYS worked rate

HOURS worked

rate amount paid

Massachusetts Teachers’ Retirement System: Service credit purchase application Applicant’s name

Substitute, temporary or part-time public school service in Massachusetts

MTRS member number

Section 3, Supplemental sheet for use as needed

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