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XXXX X RECORD OF PRIOR SERVICE

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SB146 e-form (3/15) PAGE 1
PART A: Please complete the following information.
First Name
MI
Last Name
Social Security Number (last 4 digits only)
Permanent Home Address
Apt. No.
TRS Membership Number
City
State
Zip Code
Primary Phone Number (Check one: Home Work Mobile)
Alternate Phone Number (Check one: Home Work Mobile)
Please keep your personal information with TRS up to date. We will update our records based on the information you provide above,
so do not enter a temporary address
.
If you are providing new information above, please indicate the effective date:
X
XXXX
RECORD OF PRIOR SERVICE
(FOR TIERS III, IV, AND VI MEMBERS)
(MM/DD/YYYY)
➤ Submit this form to inform TRS of service you rendered for a public employer within New York State before joining TRS.
TRS will research your service claim and contact you about purchasing credit for eligible service.
➤
Do not enter service rendered for the New York City Department of Education (DOE); TRS has your DOE service records.
➤ If you are transferring your membership to TRS or applying for a membership/tier reinstatement, do not file this form
until that process is complete.
➤
Please read the full instructions on pages 3 and 4 before completing this form.
CONTINUED ON PAGE 2
PART B: RECORD OF PRIOR SERVICE*
1.
DATES OF SERVICE (MM/DD/YYYY): FROM TO
TITLE/POSITION: FULL-TIME OR PART-TIME
EMPLOYER INFORMATION NAME OF EMPLOYER (if not in list at left)
2.
DATES OF SERVICE (MM/DD/YYYY): FROM TO
TITLE/POSITION: FULL-TIME OR PART-TIME
EMPLOYER INFORMATION NAME OF EMPLOYER (if not in list at left)
Employer Code and Name q
*List each title/position separately, even if you rendered the service for the same employer.
Employer Code and Name q
Select Employer Code & Name (Use 999 if employer not listed)
Select Employer Code & Name (Use 999 if employer not listed)
SB146 e-form (3/15) PAGE 2
CONTINUED FROM PAGE 1
PART B: RECORD OF PRIOR SERVICE*
3.
DATES OF SERVICE (MM/DD/YYYY): FROM TO
TITLE/POSITION: FULL-TIME OR PART-TIME
EMPLOYER INFORMATION NAME OF EMPLOYER (if not in list at left)
4.
DATES OF SERVICE (MM/DD/YYYY): FROM TO
TITLE/POSITION: FULL-TIME OR PART-TIME
EMPLOYER INFORMATION NAME OF EMPLOYER (if not in list at left)
5.
DATES OF SERVICE (MM/DD/YYYY): FROM TO
TITLE/POSITION: FULL-TIME OR PART-TIME
EMPLOYER INFORMATION NAME OF EMPLOYER (if not in list at left)
PART C: AFFIRMATION OF UNDERSTANDING. Please read the following statement, then enter your name and date below.
I certify that I have read the instructions on this form. I hereby request credit for the period(s) of prior service listed in Part B.
I understand that TRS will research my service claim, and will send me a Cost Letter reflecting the amount of prior service verified
by the employer(s), which may be different from what I indicate on this form. I also understand that, if I do not respond to the Cost
Letter, automatic payroll deductions may begin. I affirm that, to the best of my knowledge, all information I have provided above is true
and correct.
MEMBER’S NAME ________________________________________________________ DATE ____________________________
Note: Before submitting this form, please double-check all of the information you entered. Most versions of Adobe Reader will not
allow you to save this form to your computer; you may lose all data if you close the form without submitting it.
(MM/DD/YYYY)
*List each title/position separately, even if you rendered the service for the same employer.
CONTINUED ON PAGE 3
Employer Code and Name q
Employer Code and Name q
Employer Code and Name q
Select Employer Code & Name (Use 999 if employer not listed)
Select Employer Code & Name (Use 999 if employer not listed)
Select Employer Code & Name (Use 999 if employer not listed)
07/22/2016
Print
SB146 e-form (3/15) PAGE 3
• Submit this form if you are a Tier III, IV, or VI member and you rendered service for a public employer within
New York State before joining TRS. This service may be creditable in TRS, so TRS will research your service
claim and will send you a Cost Letter reflecting the amount of service credit available for purchase. After
purchase, this credit would be considered “prior service credit.” (Prior service is any creditable service
you rendered with a New York City and/or New York State public employer before joining TRS that was not
transferred to TRS.)
• Before completing this form, please note the following:
If you rendered service for the New York City Department of Education (DOE) before joining TRS: Do NOT
enter it on this form, since TRS already has your DOE service records and will contact you separately about prior
service credit you have available for purchase.

If you have membership in another New York City or New York State retirement system and are transferring
membership to TRS: Do NOT file this form until the transfer is complete. Since your transfer may result in an earlier
membership date or different tier, the cost to purchase service credit may be different. To initiate a membership
transfer, contact your other retirement system.
If you are a former member of TRS or any other New York City or New York State public retirement system:
It may be to your advantage to apply for reinstatement to your previous membership and/or tier (if you have not
already transferred your membership to TRS). For more information, see the “Membership/Tier Reinstatement
Request Form” (code SD42); if you want to apply for reinstatement, file that form instead. Once your reinstatement
is completed, you may file this “Record of Prior Service.”
If you performed military service: For more information, see the “Military Service Credit Request Form”
(code SD68); if you want to apply for this service credit, file that form instead.
AFTER FILING THIS FORM
• Upon receipt of this form, TRS will contact your former employer(s) to verify your prior service.
• Upon verication of your prior service, TRS will send you a Cost Letter and purchase election form indicating the cost
to purchase this service credit and the payment options available to you. We will include in the Cost Letter the amount
of prior service the employer(s) verifies, which may be different from what you indicate on this form.
• You are not required to purchase any of your prior service credit. However, if you take no action after receiving
your Cost Letter, automatic payroll deductions may begin. Your Cost Letter will explain this and your other options.
• Prior service will be credited after you have completed at least two years of membership service and upon payment
to TRS. After your prior service is credited, it will be reected in a Total Service Letter and your Annual Benets
Statement (ABS).
INSTRUCTIONS
PLEASE READ CAREFULLY
CONTINUED ON PAGE 4
RECORD OF PRIOR SERVICE
(FOR TIERS III, IV, AND VI MEMBERS)
SB146 e-form (3/15) PAGE 4
CONTINUED FROM PAGE 3
BENEFITS OF PURCHASING PRIOR SERVICE CREDIT SOONER
• Service credit is a factor in retirement allowance calculations, so purchasing prior service credit may increase your
prospective service retirement allowance.
• If you are not vested, purchasing service credit may enable you to more quickly attain vested rights and qualify for
retirement benefits.
• If you are a Tier III or IV member, purchasing service credit may enable you to more quickly attain the years of credited
service needed to stop or reduce the pension contributions you are making.
• Since the cost to purchase service credit includes interest charges that accrue over time, purchasing your prior service
credit today will cost less than doing so in the future.
GENERAL PROVISIONS
• Any request to purchase prior service credit must be made before your effective retirement date, after which you will
lose the right to request service credit.
• For more information about service credit, please refer to our service credit brochures. For your convenience, TRS
forms and publications are available on our website. If you require additional assistance, please contact our Member
Services Center at 1 (888) 8-NYC-TRS.
In Part A: Complete the information requested.
In Part B: Complete the “Record of Prior Service” as explained below. List each title/position separately, even if you rendered the
service for the same employer. If you want to provide more than five positions, please submit another “Record of Prior Service.”
DATES OF SERVICE: Provide the start and end dates of your service.
TITLE/POSITION: Enter your title/position (e.g., appointed teacher, appointed pedagogue, paraprofessional—teacher’s aide,
substitute teacher, CUNY instructional staff, CUNY adjunct). Click the applicable box to indicate whether your service was
full-time or part-time.
EMPLOYER INFORMATION: Select the three-digit code and name of your former employer from the pull-down list of
25 public employer codes most frequently used by our members. If your former employer is not included in the list, select
code “999—Other public employer within New York State”; then, enter the employer name in the box to the right.
In Part C: Read the Afrmation of Understanding and enter your name and date.
Print this form for your records before submitting.
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XXXX X RECORD OF PRIOR SERVICE

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Completed 3 May 2021

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