FRS INVESTMENT PLAN INVESTMENT PLAN EXIT CHECKLIST

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1 FRS INVESTMENT PLAN INVESTMENT PLAN EXIT CHECKLIST Name: Date: EMPLID: Position: School/Dept: PLEASE NOTE: SUBMISSION OF THIS FORM DOES NOT ENROLL YOU IN THE FRS INVESTMENT PLAN. For information on enrolling in the FRS Investment Plan, please visit our website at: INVESTMENT PLAN EXIT: Directions: Please carefully read each section and check each box as you move through the exit process. If you are mailing in the exit packet, (to the Palm Beach County School District), make sure that you send in a selfaddressed envelope with your application and we will mail a copy back to you. This will be your confirmation. FORMS FRS Investment Plan Employment Termination Form Complete the Demographic information at the top of the form (Name, SSN, position, date of birth, phone number, etc), sign and date the second page and return the form to Compensation and HR Planning A-115. Investment Plan Exit Letter and Board Policy This letter may be used to notify your principal or department head of your impending retirement. It also serves to communicate to the Benefits department that you may be eligible for continued individual health insurance coverage pursuant to Board Policy To review the policy go to the District s Policies website (found in BoardDocs) and click on the Policies tab. ( SICK TIME PAYOUT Sick time is paid out based on total FRS years of service multiplied by the maximum allowable percentage per Florida Statute. Sick time is paid out as follows: 6.. Years of service. 40% Years of service. 45% Years of service. 50% Years of service. 100% BENCOR - All employees who have 10 consecutive years of service with the District must participate in this plan. Information concerning the plan and application will be provided to you. All those who do not qualify for the plan will receive the above sick time payout as a direct deposit minus taxes. Allow a minimum of 6-8 weeks for this process. VACATION TIME PAYOUT FOR 12- MONTH EMPLOYEES Annual time is paid out to a maximum of 480 hours. BENCOR - All employees who have 10 consecutive years of service with the District must participate in this plan. Information concerning the plan and application will be provided to you. All those who do not qualify for the plan will receive the above vacation time payout as a direct deposit minus taxes. 5/16/2017

2 EMPLOYMENT TERMINATION FORM *088019* The Date of Termination can be provided on the monthly payroll file or by logging on to the Division of Retirement Online Services. This form may not be filed with the FRS Investment Plan Administrator until the member has been terminated from ALL FRS-covered employment for three calendar months following the date of termination. An exception exists for members who meet the FRS Pension Plan normal retirement requirements, in which case the form can be filed 1 calendar month following termination. Under Florida law, a member may not receive benefits under the Florida Retirement System (FRS) Investment Plan unless the member has been terminated from all employment with all FRS employers. For purposes of this form, termination" means that the member ceased all employment relationships with your agency and has been off all agency payrolls for three calendar months following the date of termination. If the member is continuing employment with your agency, in any capacity, (including temporary employment, OPS, etc.) this form should not be submitted to the FRS Investment Plan Administrator. If you have any questions, please call the Employer Assistance Line, toll-free at , Option 3. The only exception to this 3 calendar month period is if the member meets the normal retirement requirements for the FRS Pension Plan. For example, age 62 with at least 6 years of creditable service or 30 years of FRS covered service regardless of age. For Special Risk Class, age 55 with at least 6 years of special risk service or 25 years of special risk service regardless of age. If the member meets normal retirement requirements, the member may be eligible to receive a one-time distribution of up to 10% of their account balance after being off all FRS-covered payrolls for one full calendar month and the remaining balance after a total of 3 calendar months. CERTIFICATION OF TERMINATION BY FRS EMPLOYER (To be completed and signed by the Retirement Coordinator or authorized signatory on file with the FRS Investment Plan Administrator.) By completing the form below, I hereby certify that the member named below has terminated employment with this agency on: Date of Termination Social Security No: Last Name First Name MI Birth Date Please Print: Name of authorized signatory Date Employing Agency Name Signature ( ) Telephone Number Employing Agency Code Number Mail to: FRS Investment Plan Administrator PO Box Orlando, FL OR FAX to: Attn: FRS Investment Plan Administrator DO NOT MAIL HARD COPY IF FAXING Note: This form will NOT initiate a distribution. Any FRS employer who hires any retired FRS member (Pension Plan or Investment Plan) in violation of the reemployment after retirement provisions will be held jointly and severally liable for reimbursement of any FRS benefits paid. ETF-2 v F.A.C.

3 Donald E. Fennoy, II, Ed.D. Superintendent of Schools School District of Palm Beach County 3300 Forest Hill Boulevard, Suite C-316 West Palm Beach, FL Dear Dr. Fennoy, This is to notify you of my intent to retire from the Palm Beach County School system. I am in the Investment Plan and will meet the requirements of Board Policy 3.79 which may entitle me to continue receiving individual health insurance coverage under the District s plan. My last day of service as at (Position) will be (School/Department) (Retirement Date) I understand that my name will be presented to the School Board on the next scheduled personnel agenda. I have completed my exit interview and have filled out all necessary retirement paperwork in the Department of Compensation & Employee Information Services. Sincerely, (Signature) (Date) (Printed Name)

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5 THE SCHOOL DISTRICT OF PALM BEACH COUNTY COMPENSATION & EMPLOYEE INFORMATION SERVICES Address and/or Telephone Number Change for Former Employees Today's Date Employee ID # OR Employee SS # xxx - xx - Employee Name (first, middle initial, last) FORMER ADDRESS/PHONE NUMBER Former Street Address City State Zip Code Former Home Phone # Former Cell Phone # NEW ADDRESS/PHONE NUMBER New Street Address City State Zip Code New Home Phone # New Cell Phone # Mail to: The School District of Palm Beach County Compensation & Employee Information Services 3300 Forest Hill Blvd., Suite A-152 West Palm Beach, FL Signature Date OR Fax to: Compensation & Employee Information Services (561) PBSD 0108 (Rev. 08/15/2012) ORIGINAL - Compensation & Employee Information Services