SECTION 16 EMPLOYMENT OF OHIO SECTION 17 PUBLIC RETIREES

Transcription

1 SECTION 16 EMPLOYMENT OF OHIO SECTION 17 PUBLIC RETIREES Contents EMPLOYMENT OF OHIO PUBLIC RETIREES...1 Employment Limitations in Ohio Public Employment...1 Employer Procedures...2 Contributions...3 Health Care Coverage...3 Alternative Retirement Plan Contributions...3 Reemployment Benefit...3 Application for Benefits...4 Sample Reemployed retiree notification screens...5 Reemployed Retiree Record Layout...6 Sample Forms Application for Monthly Annuity or Lump-Sum Payment (Reemployed Retiree)...7 Application for Lump-Sum Payment (Reemployed Retiree Under Age 65)...11 Employers Manual Contents (6/16)

2 State Teachers Retirement System of Ohio

3 EMPLOYMENT OF OHIO PUBLIC RETIREES The information below pertains to Ohio public retirees employed as teachers while receiving retirement benefits from any Ohio public retirement system or ARP. In addition to STRS Ohio, the other five Ohio public retirement systems are City of Cincinnati Retirement System, Highway Patrol Retirement System, Ohio Police & Fire Pension Fund, OPERS and SERS. STRS Ohio members receiving disability benefits are ineligible for employment as a teacher without forfeiting their benefit. Reemployed retirees making contributions to STRS Ohio are not considered STRS Ohio members and do not have any of the rights, privileges or membership obligations except as stated in Section , R.C. Reemployed retirees in federal, out-of-state or private employment are not included under the definition of reemployed retiree in Section , R.C. EMPLOYMENT LIMITATIONS IN OHIO PUBLIC EMPLOYMENT Members planning to return to an Ohio public employment position must terminate employment from the primary (highest paying) public employer before retirement. Reemployment cannot begin until after the retirement is effective with STRS Ohio. All STRS Ohio retirements are effective on the first of the month after eligibility requirements are met. One-day break in service To be eligible for retirement, there must be a minimum one-day break in service between the last day of employment as an active member and the first day of employment as a reemployed retiree. This one day must be the last workday of the month before the retirement date or the first workday of the retirement month. The one-day break must be a normal workday and cannot be a Saturday, Sunday or holiday. For example, if the educator s retirement date is July 1 and: The educator s last paid workday is between June 1 and June 29, the first day the educator can return to work to be eligible to retire will be July 1 (as long as June 30 is a normal workday). The educator s last paid workday is June 30, the first day the educator can return to work to be eligible to retire will be July 2 (as long as July 1 is a normal workday). Single employer If a member is employed by only one Ohio public employer at the time of retirement, the member must wait two months after the retirement effective date to return to public employment. Public employment during the first two months will result in the loss of one or two months of retirement benefits. Retirees cannot volunteer in the same position from which they retired for the first two months following the retirement effective date. Multiple employers (Defined Benefit Plan members only) If a member is employed at the time of retirement by more than one employer covered by STRS Ohio, OPERS or SERS, the member may retire with the highest paying (primary) employer and continue to work with one or all of the lower paying (secondary) employers with no waiting period (see Section 6, Page 3). A secondary employer is defined as any STRS Ohio, OPERS or SERS employer where the member earned less compensation than was earned with the highest paying employer (in that fiscal year or in the previous 12-month period) and the member is continuing employment in that position with that employer in the first month of retirement. Employers Manual Page 1 (12/15)

4 To be eligible to continue to work with a secondary employer, the member must have earned compensation from that employer 12 consecutive months before and in the month of retirement to avoid a forfeiture of benefits. A member may have more than one secondary employer. The one-day break in service referenced above does not apply to secondary employer employment. EMPLOYER PROCEDURES When employing a retiree from any Ohio public retirement system or an ARP to an STRS Ohiocovered position, the employer must complete a Reemployed Retiree Notification form. The Reemployed Retiree Notification form can be submitted using one of the following methods: Completing the online form on the employer website (see sample screens on Page 5), or Transmission of a properly formatted electronic file (see Page 6). This form must be submitted within 10 days of the retiree s first date on payroll. Failure to provide notification when due may result in the employer s liability for any overpayment of benefits. Section , R.C., mandates that any school board proposing to continue the employment of a person in a position that is customarily filled by a vote of a board or commission, or to rehire a person as a reemployed retiree to the same position he or she held before retiring, must comply with the following guidelines: No less than 60 days before the employment of a reemployed retiree is to begin, the board must give public notice that the person is or will be retired and is seeking employment with the employer. Between 15 and 30 days before the employment of a reemployed retiree is to begin, the board must hold a public meeting on the issue of the person being employed. If you have any questions about Section , R.C., please contact your legal counsel. ONLINE Reemployed retiree information can be submitted through ESS on the employer website by choosing Reemployed Retiree Notification under the Application Menu (see sample on Page 5). To use ESS, you must be a registered user. See Registering to Use STRS Ohio s Employer Self Service in Section 3. SECURE FILE UPLOAD STRS Ohio accepts the transmission of data via secure file upload on the employer website. The file should be sent in the file format on Page 6. CONTRIBUTIONS Page 2 (6/17) State Teachers Retirement System of Ohio

5 Contributions for retirees should be made at the same rate as for active members. These amounts should be included in the payroll report and also reported on the annual report. No service credit needs to be reported for reemployed retirees. See Sections 3 and 5 for more information on payroll reports and annual reporting. HEALTH CARE COVERAGE Coverage under the STRS Ohio Health Care Program is limited for non-medicare enrollees employed in public or private positions. Employed enrollees are eligible only for secondary coverage through STRS Ohio s Basic Plan if they: (1) are eligible for medical and prescription drug coverage through their employer, or (2) hold a position for which similarly situated employees are eligible for medical and prescription drug coverage at the same cost as full-time employees. The rule applies to all employed enrollees who are not eligible for Medicare, regardless of hire date or type of employment. STRS Ohio requires non-medicare enrollees to verify their employment status and access to employer health coverage annually. Enrollees can provide this verification via an STRS Ohio Online Personal Account or by submitting a Verification of Employment and Employer Health Care Access form (available on the member website or upon request). ALTERNATIVE RETIREMENT PLAN CONTRIBUTIONS Reemployed retirees employed full time by a public college or university, in an academic and/or administrative position, are able to choose an ARP. Employers are required to report employees electing an ARP and contribute a percentage of the electing employee s compensation to STRS Ohio for each employee electing an ARP. These payments go toward meeting the employer s proportionate share of STRS Ohio s unfunded accrued liability. REEMPLOYMENT BENEFIT During periods of reemployment covered under one of the Ohio public retirement systems, the retiree makes contributions to the appropriate retirement system. These contributions are used to fund an additional annuity benefit or the retiree may choose a lump-sum benefit. The retiree may collect this benefit upon termination of employment. If contributions are withdrawn before age 65, the lump-sum payment is based on the member s contributions and interest. Retirees forfeit all matching funds when withdrawal occurs before the age of 65. At age 65 or after, the member may elect to receive an annuity or lump-sum withdrawal annuity amount that will be paid as a benefit. A lump-sum benefit will be paid if the annuity amount is less than $25. Payments for reemployment benefits include interest at rates approved by the Retirement Board and may include matching funds. Reemployed retirees receive full (100%) matching funds for contributions on earnings before July 1, Contributions on earnings from July 1, 2005, through June 30, 2013, receive a 50% match. For contributions on earnings on or after July 1, 2013, no matching funds will be received. Interest rates and matching percentages are subject to change without notice. Employers Manual Page 3 (6/17)

6 APPLICATION FOR BENEFITS At the time a reemployed retiree becomes eligible for and chooses to receive a benefit, the retiree should complete an Application for Monthly Annuity or Lump-Sum Payment (Reemployed Retiree) or an Application for Lump-Sum Payment (Reemployed Retiree Under Age 65). If the retiree has been employed in the current year, an employer certification will be sent to each employer to certify current year contributions. The employer should complete the online certification and submit to STRS Ohio. See the Withdrawal Certification section in the ESS instructions for details about completing this form. A sample of the Application for Monthly Annuity or Lump-Sum Payment (Reemployed Retiree) is included on Page 7. A sample of the Application for Lump-Sum Payment (Reemployed Retiree Under Age 65) can be found on Page 11. The reemployed retiree can also apply for payment via the Online Personal Account area of the member website. Page 4 (11/17) State Teachers Retirement System of Ohio

7 Reemployed retiree notification screen 1 Reemployed retiree notification screen 2 Employers Manual Page 5 (6/15) Web Screens

8 Reemployed Retiree Record Layout The following layout is required to transmit reemployed retiree notifications via secure file upload on our website. Field No. Field Name Description Start Location Field Length Format Valid Values 1 Record Type Identifies record for STRS Ohio processing. 1 4 Alphanumeric RM=Reemployed retiree 2 Employer Number 3 First Date of Service Four-character employer number (the first digit for city school districts is the letter C). Employee s first day of work after retirement. 5 4 Alphanumeric STRS Ohio employer number 9 10 MM/DD/CCYY Date 4 Social Security Number Social Security number of employee Numeric 5 Last Name 6 First Name Last name of employee. No punctuation except dash [ ]. First name of employee. No punctuation except dash [ ] Alphanumeric Alphanumeric 7 Birth Date Birth date of employee MM/DD/CCYY Date 8 Gender Gender of employee Alphanumeric F=Female, M=Male 9 Address Delivery address. No punctuation except dash [ ] Alphanumeric 10 City Name City name Alphanumeric 11 State Code United States Postal Service (USPS) abbreviation for state Alphanumeric USPS assigned state codes, **=Foreign address 12 ZIP Code ZIP code (basic 5 digits) Numeric 13 ARP Ohio Retirement System Effective Retirement Date 16 Type of Benefit Employment Under ORC Compliance With ORC Identifies higher education faculty eligible to elect an alternative retirement plan (ARP). Note: Only applicable to college and university employers (optional field). Identifies the Ohio retirement system that is paying the retirement benefit Alphanumeric Alphanumeric Member s effective date of retirement MM/DD/CCYY Date Identifies the type of retirement benefit that the member is receiving. Was the retiree reemployed under Section (Ohio Revised Code), which requires public notices be given and public meetings be held for certain rehires? Were the requirements for reemployed retirement under Section (Ohio Revised Code) met? Alphanumeric Alphanumeric Alphanumeric Y=Eligible for ARP, N=Ineligible/Not applicable OPERS=Ohio PERS, SERS=SERS Ohio, STRS=STRS Ohio, OP&F=Ohio Police & Fire, SHP=Highway Patrol, CRS=City of Cincinnati, ARP= Alternative Retirement Plan S=Age and service, D=Disability Y=Yes, the retiree was employed under Section , N=No, the retiree was not employed under Section Y=Yes, the requirements of Section were met, N=No, the requirements of Section were not met 19 Reserved Space reserved for future use Alphanumeric Total record length = , 3/16/10 Page 6 (6/16) State Teachers Retirement System of Ohio

9 APPLICATION FOR MONTHLY ANNUITY OR LUMP-SUM PAYMENT SAMPLE (Reemployed Retiree) Please note the following information regarding your reemployed annuity or lump-sum payment: 1. Section 7 (back page) of this form must be completed by the fiscal officer of your employer if: You were employed after your 65 th birthday, or You had contributing service within the last 18 months. 2. Separate applications must be certified if you had service during either of the above periods with more than one employer. The application is not complete unless it bears the school official s certification, if certification is required. 3. There are no provisions in the retirement law allowing partial withdrawals or loans. 4. STRS Ohio cannot determine the exact withdrawal or monthly annuity amount until the completed application is received from your employer. If requested, STRS Ohio will send an estimate of your lump-sum and monthly annuity amounts. 5. Your reemployed account check will be mailed to the address shown on this application unless STRS Ohio receives written notice of your change of address. Your funds will be rolled over if you complete Section 3. You may request a direct deposit of your funds by providing bank information in Section Federal tax requirements state account withdrawal checks must be issued between Special Tax Notice Mailed 30 and 180 days from the date STRS Ohio mails special tax information to you. If more than 180 days have passed from the Special Tax Notice Mailed date shown in the box to the right, please contact STRS Ohio for a new application. Your signature in Section 6 indicates you wish to waive the 30-day waiting period. Please call us if you do not wish to waive this waiting period. 7. Section 6 must be signed. If the application is not signed, it will be returned to you. Section 1 General Information (Please print in ink.) Effective date is the first of the month following last date of service, Effective date attainment of age 65 or 12 months after the effective date of a Month Year previous reemployed benefit payment, whichever is later , 5/17/3M Name First Middle Last Retiree s Social Security number or STRS Ohio account number Home address Street address City State ZIP code Phone ( ) Birth date Area code 1 (continued) Employers Manual Page 7 (6/17) Sample Form (Page 1)

10 Section 2 Payment Selection (Check one box.) o LUMP-SUM PAYMENT I elect to withdraw my contributions, matching contributions as determined by the State Teachers Retirement Board and interest in one lump-sum payment. (If you would like to roll over your lump-sum payment, please complete all information in Section 3 and sign and date Section 6. If you do not want to roll over your payment, please review and complete Direct Deposit to Bank Account in Section 4, Income Tax Withholding on Lump-Sum Payments in Section 5a and sign and date Section 6. o MONTHLY ANNUITY (Available only if monthly benefit equals or exceeds $25.) I elect to draw a lifetime monthly annuity. (If you are taking a monthly annuity, please complete all information in Section 4, Section 5b and Section 6.) At the time of my death, if funds remain from my contributions, matching contributions as determined by the State Teachers Retirement Board or interest, the balance is payable to my beneficiary* listed below: Beneficiary name First Middle Last Social Security number or Relationship Birth date STRS Ohio account number *If you wish to name more than one beneficiary, please call STRS Ohio toll-free at for further instructions. Section 3 Direct Rollover Instructions for Lump-Sum Payment Option 1. Retirement plans eligible for direct rollovers include traditional individual retirement accounts (IRAs), Roth IRA, SEP-IRA, SIMPLE IRA, 403(b) plans, 457(b) governmental plans and retirement plans qualified under Internal Revenue Code Section 401(a). 2. Retirement plans are not required to accept rollovers and many retirement plans do not accept nontaxable contributions. Please check with your plan. 3. Please also refer to the enclosed Special Tax Notice Regarding Lump-Sum Payments for tax restrictions applicable to rollovers before completing this section. I wish to directly roll over all or part of my eligible payment to an eligible retirement plan and have confirmed that my plan administrator accepts direct rollovers from Section 401(a) retirement plans. Rollover distribution to be made payable to: Name of financial institution or plan trustee Attention Address of financial institution Street address City State ZIP code SAMPLE Account number with institution (required) Type of account Traditional IRA 401(a) qualified plan, including 401(k) Amount of rollover 100% (check one) Roth IRA 403(b) (check one) $ SEP-IRA 457(b) governmental plan % SIMPLE IRA Other Complete as applicable: o I understand that any money remaining in my account after the above amounts are rolled over will be paid directly to me and any taxable amounts will be subject to 20% federal income tax withholding. o Mail rollover check, payable to my specified eligible retirement plan, to my home address. Note: The financial institution s address is still required above , 5/17/3M 2 Page 8 (6/17) Sample Form (Page 2) State Teachers Retirement System of Ohio

11 Section 4 Direct Deposit to Bank Account* (Choose one type of account.) Required for monthly annuity payments; optional for lump-sum payments. If this section is not completed, any funds not rolled over will be mailed to the address provided in Section 1. o SAVINGS or INVESTMENT ACCOUNT o CHECKING (Please attach a voided check to this form or provide the account number and routing number below.) Name of financial institution Joint account holder Financial institution phone ( ) Area code *For an investment account, ask your plan to provide direct deposit information on a form or letter and include a copy with this application. For a savings or checking account, include account information in the space provided above. You may also update your bank information through your Online Personal Account at Section 5 Income Tax Withholding 5a. INCOME TAX WITHHOLDING ON LUMP-SUM PAYMENTS: Under federal law, STRS Ohio must withhold 20% federal income tax on all lump-sum payments eligible for rollover and paid directly to you. To withhold a higher percent, indicate here: I elect to have more than 20% federal tax withheld from my total lump-sum payment. Percent to withhold: %. If you are over age 70-1/2, a portion of your payment is a required minimum distribution not eligible for rollover. You may request a different percentage of withholding on that portion. I elect to have % withheld from the required minimum distribution portion of my payment, if any. I understand 20% will be withheld from any amount paid directly to me that is not a required minimum distribution. Ohio withholding for Ohio residents only (If no election is made, STRS Ohio will process your application without Ohio state tax withholding.) o I request the following amount be withheld for Ohio tax:. o I do not want Ohio state tax withheld from my STRS Ohio benefit. This choice does not release you from Ohio tax obligations if you live in Ohio. 5b. INCOME TAX WITHHOLDING ON MONTHLY ANNUITY: Federal withholding (Choose Option 1, 2 or 3.) 1. I do not want federal income tax withheld from my STRS Ohio benefit. 2. Marital status: Single Married. Number of allowances (See Optional additional withholding below.) 3. Married, but withhold at higher single rate. Allowances will be zero. (See Optional additional withholding below.) Optional additional withholding In addition to the calculated withholding in Option 2 or 3 selected above, I want additional tax withheld of per month. If necessary, I give STRS Ohio permission to correct my withholding request based on clarification obtained through a phone call to me. If no election is made, I understand STRS Ohio will process my application using the tax status of married with three allowances. Ohio withholding for Ohio residents only (If no election is made, STRS Ohio will process your application without Ohio state tax withholding.) I request the following monthly amount be withheld for Ohio tax. Whole dollar amount or percentage I do not want Ohio state tax withheld from my STRS Ohio benefit. This choice does not release you from Ohio tax obligations if you live in Ohio. The state of Ohio provides STRS Ohio with a voluntary withholding program. STRS Ohio withholds only Ohio income tax and only upon your request. If you live outside of Ohio, you may wish to contact a tax consultant concerning the income tax laws of that state. You may initiate or change federal or state withholding from monthly benefits at any time. Contact STRS Ohio for the appropriate forms. SECTION 6 Acknowledgment of Reemployed Retiree I provided the requested information to the best of my knowledge. I also certify I am not under any agreement or employment contract for future teaching service. I understand this application must be received by STRS Ohio within 180 days from the Special Tax Notice Mailed date indicated on the front of this application. Signature Date (continued) , 5/17/3M Tape voided check here (do not staple). OR Account 9-digit routing number or transit number SAMPLE Employers Manual Page 9 (6/17) Sample Form (Page 3)

12 Social Security number or Name STRS Ohio account number EMPLOYER CERTIFICATION Photocopy this page and distribute one page to each employer. Section 7 To Be Completed by Fiscal Officer This section is to be completed by the school fiscal officer if the applicant has worked at any time past age 65 even if not currently employed by an STRS Ohio-covered employer or if the applicant had contributing service within the last 18 months. Under Ohio law, employers must verify information and certify only accurate and correct information about an applicant s contributions. This information is used to determine payment due the applicant. Employers are required to reimburse STRS Ohio for any overpayment of funds resulting from an error in employer certification. I certify to the best of my knowledge the member named above, who is applying for an STRS Ohio reemployed benefit payment, is not currently under contract with this employer in an STRS Ohio-contributing position as defined in retirement law; is not on leave of absence from such employment; does not have any other contractual status; is not an applicant for such employment, including substitute teaching; and is under no verbal or written agreement for future teaching. Last date of service for which STRS Ohio compensation was earned... Last date on payroll... Total STRS Ohio compensation earned... Retirement contributions (to be reported on Annual Report): Employee contributions taxed... Employee contributions tax-deferred or picked up... Note: Employee contribution rate is 14%. Year Year Fiscal officer s signature Date Employer Title Employer number Phone ( ) Area code Fiscal Year* Year Year SAMPLE *If you are completing this form July through October and the applicant worked after June 30, you must complete the information for the previous fiscal year ended June 30 and the current fiscal year ec, 5/17/3M 4 Page 10 (6/17) Sample Form (Page 4) State Teachers Retirement System of Ohio

13 APPLICATION FOR LUMP-SUM PAYMENT (Reemployed Retiree Under Age 65) Section 1 General Information (Please print in ink.) Name First Middle Last Retiree s Social Security number or STRS Ohio account number Home address Street address City State ZIP code Phone ( ) Birth date Area code Effective date Please note the following information regarding your reemployed lump-sum payment: 1. Section 6 on Page 4 of this form must be completed by the fiscal officer of your employer. 2. Separate applications must be certified if your final year of service was with more than one employer. The application is not complete unless it contains the school official s certification. 3. There are no provisions in the retirement law allowing partial withdrawals or loans. 4. STRS Ohio cannot determine the exact withdrawal amount until the completed application is received from your employer. If requested, STRS Ohio will send an estimate of your lump-sum amount. 5. Your reemployed account check will be mailed to the address shown on this application unless STRS Ohio receives written notice of your change of address. Your funds will be rolled over if you complete Section 2. You may request a direct deposit of your funds by providing bank information in Section Section 5 on Page 3 of this form must be signed. If the application is not signed, it will be returned to you. Income Tax Month Year Effective date is the first of the month following last date of service or 12 months after the effective date of a previous reemployed benefit payment, whichever is later. Federal tax requirements state account withdrawal checks must be issued between 30 and 180 days from the date STRS Ohio mails special tax information to you. If more than 180 days have passed from the Special Tax Notice Mailed date shown in the box to the right, please contact STRS Ohio for a new application. Your signature in Section 5 indicates you wish to waive the 30-day waiting period. Please call us if you do not wish to waive this waiting period. Special Tax Notice Mailed SAMPLE Under federal law, STRS Ohio is required to withhold 20% federal income tax from the taxable amount of all lump-sum payments exceeding $200. If you elect a direct rollover to a qualified plan, you will not be subject to the 20% federal income tax with holding. If you are under age 59-1/2, additional taxes and penalties may apply. Please consult a tax advisor. Important note: If you take a refund of your reemployed account before age 65, the lump-sum amount consists of contributions you have made plus interest, if eligible, at a rate set by the State Teachers Retirement Board through the end of the month in which your last day of contributing service occurred or 12 months after the payment of a previous reemployed benefit payment, (continued) , 9/16/200 1 Employers Manual Page 11 (12/16) Sample Form (Page 1)

14 whichever is later (interest rates are subject to change). If you wait until attaining age 65, the lump-sum amount may also include a percentage of matching contributions plus interest, or you may qualify to receive a monthly annuity benefit in lieu of a lump-sum payment. Taking a refund of your account before age 65 cancels your rights to an annuity or refund that may include matching contributions and interest on those contributions. Section 2 Direct Rollover Instructions 1. Retirement plans eligible for direct rollovers include traditional individual retirement accounts (IRAs), Roth IRAs, 403(b) plans, 457(b) governmental plans and retirement plans qualified under Internal Revenue Code Section 401(a). 2. Retirement plans are not required to accept rollovers and many retirement plans do not accept nontaxable contributions. Please check with your plan. 3. Please also refer to the enclosed Special Tax Notice Regarding Lump-Sum Payments for tax restrictions applicable to rollovers before completing this section. I wish to directly roll over all or part of my eligible payment to an eligible retirement plan and have confirmed that my plan administrator accepts direct rollovers from Section 401(a) retirement plans. Rollover distribution to be made payable to: Name of financial institution or plan trustee Attention Address of financial institution Street address City State ZIP code Account number with institution (required) Type of account Traditional IRA Amount of rollover 100% (check one) Roth IRA (check one) 401(a) 403(b) 457(b) governmental plan Other % Complete as applicable: o I understand that any money remaining in my account after the above amounts are rolled over will be paid directly to me and any taxable amounts will be subject to 20% federal income tax withholding. o Mail rollover check, payable to my specified eligible retirement plan, to my home address. Note: The financial institution s address is still required above. SAMPLE , 9/16/200 2 Page 12 (12/16) Sample Form (Page 2) State Teachers Retirement System of Ohio

15 Section 3 Direct Deposit to Bank Account* (Choose one type of account.) If this section is not completed, any funds not rolled over will be mailed to the address provided in Section 1. o SAVINGS or INVESTMENT ACCOUNT Account number 9-digit routing or transit number Name of financial institution Joint account holder SAMPLE Financial institution phone ( ) Area code o CHECKING (Please attach a voided check to this form or provide the account number and routing number in the box below.) Tape voided check here (do not staple). OR Account number 9-digit routing or transit number Name of financial institution Joint account holder Financial institution phone ( ) Area code *For direct deposit to an investment account, please ask your investment plan to provide direct deposit information on a form or letter. Include a copy of the form or letter with this application. For a savings or checking account, include account information in the space provided above. You may also update your bank information by logging in to your Online Personal Account at Section 4 Income Tax Withholding Income tax withholding on lump-sum payments: Under federal law, STRS Ohio must withhold 20% federal income tax on all lump-sum payments that are eligible for rollover and paid directly to you. If you would like an amount greater than 20% withheld, please indicate the percent of tax to withhold (cannot be less than 20%): %. Ohio withholding for Ohio residents only (If no election is made, STRS Ohio will process your application without Ohio state tax withholding.) o I request the following amount be withheld for Ohio tax:. o I do not want Ohio state tax withheld from my STRS Ohio benefit. This choice does not release you from Ohio tax obligations if you live in Ohio. The state of Ohio provides STRS Ohio with a voluntary withholding program. STRS Ohio withholds only Ohio income tax and only upon your request. If you live outside of Ohio, you may wish to contact a tax consultant concerning the income tax laws of that state. Section 5 Acknowledgment of Reemployed Retiree I reviewed this completed application and elect to withdraw my contributions and interest in a lump-sum payment. I understand that by taking a lump-sum payment before attaining age 65, I am forfeiting the right to any potential matching contributions and interest, and I am not eligible to receive a monthly annuity benefit. I provided the requested information to the best of my knowledge. I also certify I am not under any agreement or employment contract for future teaching service. I understand this application must be received and payment issued by STRS Ohio within 180 days from the Special Tax Notice Mailed date indicated on the front of this application. Signature Date (continued) , 9/16/200 3 Employers Manual Page 13 (12/16) Sample Form (Page 3)

16 Social Security number or Name STRS Ohio account number EMPLOYER CERTIFICATION Photocopy this page and distribute one page to each employer. Section 6 To Be Completed by Fiscal Officer This section is to be completed by the school fiscal officer. Under Ohio law, employers must verify information and certify only accurate and correct information about an applicant s contributions. This information is used to determine payment due the applicant. Employers are required to reimburse STRS Ohio for any overpayment of funds resulting from an error in employer certification. I certify to the best of my knowledge the member named above, who is applying for an STRS Ohio reemployed benefit payment, is not currently under contract with this employer in an STRS Ohio-contributing position as defined in retirement law; is not on leave of absence from such employment; does not have any other contractual status; is not an applicant for such employment, including substitute teaching; and is under no verbal or written agreement for future teaching. Last date of service for which STRS Ohio compensation was earned... Last date on payroll... Total STRS Ohio compensation earned... Retirement contributions (to be reported on Annual Report): Employee contributions taxed... Employee contributions tax-deferred or picked up... Note: Employee contribution rate is 14%. Year Year Fiscal officer s signature Date Employer Title Employer number Phone ( ) Area code Fiscal Year* Year Year SAMPLE *If you are completing this form July through October and the applicant worked after June 30, you must complete the information for the previous fiscal year ended June 30 and the current fiscal year ec, 9/16/200 4 Page 14 (12/16) Sample Form (Page 4) State Teachers Retirement System of Ohio