Fillable You must provide this form to NPERS whenever (Nebraska)

Fill Online, Printable, Fillable, Blank You must provide this form to NPERS whenever (Nebraska) Form

Use Fill to complete blank online NEBRASKA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

You must provide this form to NPERS whenever (Nebraska)

On average this form takes 12 minutes to complete

The You must provide this form to NPERS whenever (Nebraska) form is 1 page long and contains:

  • 0 signatures
  • 12 check-boxes
  • 41 other fields

Country of origin: US
File type: PDF

BROWSE NEBRASKA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
NPERS2400 NPERS2405 NPERS2406
Rev. 03/2018
Page 1 of 2
BAR CODE
Last First Middle
Name
Position
Date of Birth - -
Plan Type
(Check one.)
Social Security Number - -
Personal Email Address
School
Address City State Zip
Home Phone
Or Cell Phone
Work Phone
Employer
Non-Contributing School Member Form
You must provide this form to NPERS whenever a member has an interruption in retirement contributions. If retirement contributions
cease because of a “termination of employment,” it is the responsibility of the employer to notify NPERS, in writing, of the date upon
which a termination of employment has occurred.
IMPORTANT: Please complete this form accurately. Retirement benefits are date sensitive. If the information on this form does not
match the information posted to the member’s account, you will be contacted for clarification and/or corrections.
Please answer the following questions regarding the member’s employment status.
(Please note, to determine a member’s eligibility for retirement benefits, we may require further documentation.)
REASON
FOR NOT
CONTRIBUTING:
Retired Resigned Disabled Military Leave Leave of Absence Deceased
Transferred/merged to another Nebraska school (Date: _________/_________/______________)
Other (explain)_____________________________________________________________________________
1. Is the member on an approved leave of absence? Yes No
If YES, when will the leave of absence end: _________________________
If YES, is the leave of absence:
Paid Unpaid
2. If NO to question 1, what is the member’s termination date? ___________________________________
IMPORTANT: “Termination of employment” is defined in the Nebraska School Employees Retirement Act. It is important to
report an accurate date of termination. An inaccurate date could delay payment of the member’s benefit or result in the member
having to repay benefits. If you are unclear as to what date to use, please contact NPERS for clarification. NPERS reserves the
right to request further information to verify the member’s employment status. See the reverse side of this form for further
information.
3. The member’s final retirement compensation will be / was reported on the following Wage and
Contribution Report: , which was / is due on:
4. The member’s final service hours will be / was reported on the following Wage and
Contribution Report
: , which was / is due on:
The final service hours on the above report
will be / were worked over the following
period:
I declare to the best of my knowledge and belief that the above information is true and correct.
Signature of Employer Contact: ____________________________________________ Title: _________________________________
Printed Name of Employer Contact : ________________________________________ Date: _________________________________
________ / ________
MONTH YEAR
________ / ________
MONTH YEAR
________ 10
th
, ________
MONTH YEAR
________ 10
th
, ________
MONTH YEAR
____ / ____ / ______ to ____ / ____ / ______
MONTH DAY YEAR MONTH DAY YEAR
Beginning date = first Ending date = final day member
day of payroll period. rendered service or used leave.
PRINT
NPERS2400 NPERS2405 NPERS2406
Rev. 03/2018
Page 2 of 2
BAR CODE
Termination of Employment – What does it mean?
A member of the School Employees Retirement Plan is not entitled to a retirement benefit until after he/she has terminated
employment. “Termination of employment” has a very specific meaning in the School Employees Retirement Act. In short,
termination of employment occurs on the date on which the member experiences a bona fide separation from service of
employment.
It is important to note that the definition of termination of employment does not mean the last day that the member physically
worked. The last day that the member physically worked and the member’s termination date may coincide, but the 2 dates are
distinctly different.
NPERS relies on the reported information on this form to process the member’s retirement benefit. It is very important that a proper
determination is made with respect to the member’s reported termination date. If the PERB determines that a member received an “in
service distribution” due to the reporting of an incorrect termination date, the law requires the member who has received such benefit
to repay the benefit to the retirement system.
Please review the following examples of the most common termination scenarios. This is not an exhaustive list.
• EXAMPLE A: AN EMPLOYEE WITH A STANDARD CONTRACT.
A member is contracted to work from August 18, 20xx through May 26, 20xx; 186 days at full-time. This is an example of a
standard (teaching) contract with no “extended” contract days or no extra duty after the end of the member’s contract. The
salary for this service is normally paid over the 12-month period (Sept – Aug). In this example, record May 26, 20xx as the
member’s date of termination.
• EXAMPLE B: AN EMPLOYEE WITH AN EXTENDED CONTRACT (10 EXTRA DAYS).
A member is contracted to work from August 18, 20xx through June 10, 20xx; 196 days at full-time. The salary for this
service is normally paid over the 12-month period (Sept – Aug), same as the member with the standard contract. In this
example, record June 10, 20xx as the member’s date of termination.
In this example, in the year of retirement, the member completed all of his/her 196 contract days by May 31, 20xx. This
does not change the member’s termination date. It is still June 10, 20xx. It is not correct to record May 31, 20xx as the
member’s termination date (remember…the last physical day of work is not the defintion of termination of employment). The
member’s contractual end date is what determines the member’s termination date.
• EXAMPLE C: AN EMPLOYEE CEASES EMPLOYMENT BEFORE COMPLETION OF HIS/HER CONTRACT.
A member is contracted to work from August 18, 20xx through May 26, 20xx; 186 days at full-time. The salary for this
service is normally paid over the 12-month period (Sept – Aug). The member resigns on April 15, 20xx, completing 156
out of 186 contracted days. In this example, record April 15, 20xx as the member’s termination date. The
compensation and service hours must be reported to NPERS only to the extent of the portion of the employment
contract that was completed (156 days). Do not report compensation and service hours beyond the 156 days.
• EXAMPLE D: AN EMPLOYEE CEASES WORKING AND THEN IS ON AN UNPAID LEAVE OF ABSENCE.
A member is contracted to work from August 18, 20xx through May 26, 20xx; 186 days at full-time. The salary for this
service is normally paid over the 12-month period (Sept - Aug). The member’s last physical day of work is on April 15,
20xx. The member then goes on an upaid leave of absence and then eventually resigns effective August 15, 20xx. A
member on a leave of absence is still considered employed. In this example, record August 15, 20xx as the termination
date (the resignation date). The compensation and service hours must be reported to NPERS only to the extent of
the portion of the employment contract that was completed (156 days).
• EXAMPLE E: AN EMPLOYEE DIES IN SERVICE.
Follow Example C for a member that dies unexpectedly, before the completion of his/her contract. Record the member’s
date of death as the termination date. Compensation and service hours must be reported to NPERS only to the extent of
the portion of the employment contract that was completed (as described in Example C).
• EXAMPLE F: USING VACATION AT THE END OF A CONTRACT.
An employee is contracted to work August 1, 20xx through July 31, 20xx; 240 days at full-time. The member is a 12-month
employee and is normally paid over the same 12-month period (Aug - July 31). The member “works” August 1 through June
30 every year and uses vacation in July of every year. Do not record June 30 as the member’s termination date. If the
member is “using” vacation time, it is considered “work” time. In this example, you should record July 31 as the member’s
termination date. Service hours and salary should be reported for July.
The PERB is required to administer the Plan in a manner that maintains the Plan’s qualified status under the Internal Revenue
Code (IRC). In those instances where an inconsistency is identified, NPERS will investigate and may request further documentation
in order to substantiate reported information. If you have any questions about this form, please call NPERS.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

You must provide this form to NPERS whenever (Nebraska)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 5 March 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document