|
State
Police Retirement System
Instructions for Forms and Applications
Pertinent to Retirement
The
SPRS Application for Retirement Allowance
BACK
TO TOP
Instructions
for the SPRS Retirement Application
The SPRS
Application for Retirement Allowance is completed in its
entirety by the member. The member's signature must appear on
the form. The signature and witnessing signature by the Superintendent
(or authorized representative) will be verified when the application
is keyed into the Division's system.
The membership number is requested
at the top of the application.
Items 1-6. Member Information
On the first page of the application
give the member's mame, address, Social Security number, date
of birth (proof of age
will be required from the member if it has not already been submitted),
and the member's phone numbers at home and work.
Item 7. The member needs to inform the Division if an outstanding
loan (if any) will be "carried" into retirement or will
be paid in full prior to retirement.
- All retirees can 'carry' their
loans into retirement at the same monthly repayment level as
when they were active members.
- Biweekly loan payment schedules
are converted to monthly payments by multiplying the biweekly
payment by 2.175.
- The member may choose to pay
off the loan in a lump sum.
- Interest will continue to accrue
at 4.00% if the member chooses to 'carry' the loan into retirement.
Item 8. Effective Retirement Date
of Member.
Provide the member's effective date
of the retirement (always the first of a month). The application
must be received in the Division prior to the member's effective
retirement date.
Item
9. Type of Retirement Requested
Service:
Age 55, any number of years of service credit.
Special:
25 years of Service Credit, regardless of age.
Deferred:
Ten or more years of Service Credit but under age 55.
Item
10. Member's Marital Status
Indicate here the member's marital
status.
Items 11-13. Name of Spouse, Social
Security Number and Birth Date.
This information is required if either
married or separated. If not married at the time of retirement
this space may be left blank or write "N/A."
Line 14 - Name, Gender,
Birth Date and Social Security Number of Eligible Dependent Children.
List all dependent children under
age 18, or who are mentally or physically handicapped regardless
of age. Copies of birth certificates, adoption papers, and
medical documentation proving disability are required for each
child listed.
If additional space is needed, the
member may attach additional sheets. If additional sheets
are needed to list dependent children, these also must be signed.
Designation of Group Life Insurance
Beneficiary(ies).
Group Life Insurance
Non-disability retirees must have
at least 10 years service credit to qualify for group life insurance
death benefits. Disability retirees qualify upon retirement approval
if they have life insurance as active members.
Primary Beneficiary(ies)
Those listed here receive the group
life insurance, if any, at the time of death. If the member chooses
multiple primary beneficiaries and one beneficiary predeceases
the member, the remaining beneficiary(ies) will usually share
that beneficiary's portion. Some special designations are allowable,
but uncommon. Unless otherwise stated, if multiple beneficiaries
are listed, they are considered "share and share alike."
If the member had no active group life insurance coverage through
the pension fund, then the member will not have group life insurance
coverage as a retiree.
The following information should
be provided:
Contingent Beneficiaries
Contingent beneficiaries are paid
only if all the primary beneficiaries predecease the member. The
same information is needed for these beneficiaries as for the
primary beneficiary(ies).
Additional primary or contingent
beneficiaries can be listed on an attached and signed sheet.
SIGNATURE OF APPLICANT
The application must be signed or
it cannot be processed. If any additional sheets for the retirement
application are attached, then these additional sheets must also
be witnessed by the signature of the Superintendent or the authorized
representative.
SIGNATURE OF SUPERINTENDENT OF
THE DIVISION OF THE NEW JERSEY STATE POLICE
The Superintendent or designated
representative must also sign the application to verify the member's
intention to retire and validate the application.
BACK
TO TOP
Certification
of Service and Final Salary—SPRS Retirements
The certification
form is completed by the member's employer.
BACK
TO TOP
Item
1. Name of Member
Item 2. Membership Number
Item 3. Social Security Number
Item 4. Date of Termination of
Service
This certifies that the member will
not render any service or earn any salary after this date.
Item
5a. Is the member currently on suspension?
If
this is answered YES, the employer is to state the date suspension
began and mark the box stating if the member is PAID or UNPAID
while on suspension.
Item
5b. Is the applicant facing disciplinary action or indictment?
If this is answered YES, a detailed
explanation must be submitted by the employer. The Division
will review the explanation to determine if it is sufficient for
continued processing, if additional information is needed, or
if submission to the SPRS Board of Trustees is required.
IF either 5a or 5b are answered YES,
copies of the preliminary and final notices of disciplinary action,
or the equivalents, or a copy of the indictment should be included.
Item 6. Unpaid Leaves of One Month
or More, within the Last 12 Working Months
This information shows gaps in service
due to Leave of Absence (LOA). Some LOAs can be purchased by the
member. A LOA for a work related incident may indicate a possible
Worker's Compensation claim. If Worker's Compensation is determined,
the employer may be required to submit pension contributions,
until retirement, on the member's behalf.
Item 7. Base Salary Subject to
Pension Fund Contributions Paid for the Last Full Year of Service.
The last 12 months of salary must
be indicated. Salary should be reported by the number of months
at a given salary, the amount of the monthly base salary, the
beginning and ending dates of that salary and the total base salary
for the period. Salary is being certified in advance. Therefore
salary not yet paid is to be projected to the best of the employer's
ability.
Item 8. Has the member received
a significant annual salary increase in the last 3 years of employment?
If the answer is yes, the employer
must furnish cause for the increase, with documentation.
The Division may approve the increase, if justifiable, deny the
increased salary, or forward the case to the Board of Trustees
for determination.
Item 9. Has there been any retroactive
salary paid to the employee within the past three years?
A retroactive salary increase can
falsely inflate a member's salary if it is not properly credited
back to the correct dates. Retroactive salaries can also incorrectly
show a single salary increase, when in fact it may cover several
years of increases. The beginning and ending dates for each
retroactive increase and the corresponding new annual base salary
should be indicated.
If the member receives a retroactive
raise after the original Certification has been sent to the Division,
a new Certification must be sent in. The new Certification should
state 'Amended' or 'Revised for Retroactive Increase.'
Completed by denotes who actually
completed the form.
Phone Number
The phone number of the person who
completed the form. This number allows us to directly contact
the employer for any follow up questions we may have on the Certification.
Signature of Superintendent or
Authorized Representative
The Superintendent or Authorized
Representative, who is the individual responsible for certifying
that the information provided on this form is correct, must sign
this form. This signature must be an original signature and can
not be a stamped signature.
Date
The date ndicates when the form was
signed by the Superintendent. The signature date is helpful information
when more than one Certification is received, by ensuring that
the most recent Certification is used. Usually more than one Certification
is received when there is a retroactive raise (marked "Revised
for Retro" or "Retroactive Raise"), or a change
in the Certification (marked "Amended").
NOTE CONCERNING WORKERS' COMPENSATION:
If the member is receiving periodic payments from Workers' Compensation,
the employer may be required to pay the member's pension contributions
until the member's effective date of retirement. Not all Workers'
Compensation payments are pensionable. No loan payments, back
deductions, or arrears payments are required from the member or
the employer while the member is on Workers' Compensation. Whenever
possible, an official statement of the Workers' Compensation award,
showing the amount of the periodic benefits and the beginning
and ending dates of the benefits awarded, should be attached or
mailed in under separate cover.
BACK
TO TOP
The SPRS Application
for Disability Retirement
BACK
TO TOP
Instructions
for Completing the
SPRS Application for Disability Retirement
The SPRS Application For Disability
Retirement is completed in its entirety by the member.
The member's signature must be notarized. The signature and notarization
will be verified when the application is keyed into the Division's
system.
Part One
Lines
1-6:
Request basic member information:
Membership Number, SSN (Social Security Number), member's Name,
Date of Birth (Proof-of-Age will be required from the member if
it has not already been submitted), member's Home Mailing Address,
Home Phone and Work Phone numbers.
Line
7:
Asks to supply the Division with
the official Work Title under which the member is currently employed.
Line 8 - Type of Disability Retirement:
The type of Disability Retirement
requested: Accidental Disability or Ordinary Disability. (See
also Fact Sheet #39).
Line 9: "I declare that
I am incapacitated for further service in the work title listed
in Item 7 due to the following reasons:
This question should be answered
by the member explaining in what way a disabling condition prevents
continued service in the job title listed in question 7.
This should be completed in the member's own words, and should
reflect the pertinent job duties that fall under the specific
job title.
Line10 - Retirement Effective
Date:
The effective date of the retirement
(always the first of a month). The application must be received
in the Division prior to the member's effective retirement date.
Line 11 - If you will have an
outstanding loan balance at retirement, how do you want to pay
the loan off?
All retirees can 'carry' their loans
into retirement at the same monthly repayment level as when they
were an active member (Biweekly loan payments are converted to
monthly payments by multiplying the biweekly payment by 2.175).
The member can still pay off the loan in a lump sum. Interest
will continue to accrue at 4.00% if the member chooses to 'carry'
the loan.
Line 12 - Are you currently under
departmental charges of formal indictment?
If the member is under charges or
formal indictment, additional information will be required from
the employer and/or the member. Delay in receiving this information
could delay the processing of the member's pension.
BACK TO TOP
Lines 13 and 14 must be answered for Accidental Disability
only.
Line 13 - Date of Accident and
Description:
The date of accident will be the
date of the traumatic event that directly caused the totally and
permanently disabling condition.
The accident description and list
of witnesses provides the member the opportunity to tell in his
or her own words valuable information that may prove helpful in
determining eligibility for accidental disability retirement.
Line 14 - Has a Claim Been Filed
for Workers' Compensation?
If yes, then the member must attach
a copy of the award. The member should complete questions 14a,
14b and 14c:
- Amount of Periodic Benefits
(stated as a weekly dollar amount),
- Beginning date of award
(when the award was effective) and
- Ending date of award (when
the award's benefit concludes).
If the member has filed for Workers'
Compensation and the award is still pending, the member should
forward the information to the Division as soon as possible. (See
Fact sheet #45)
BACK
TO TOP
Part
Two: Marital Status and Children
Line
15:
Indicate Here the Member's Marital
Status.
Line 16 - Name of Spouse:
Blank or N/A if none. This information
is needed for the letter to the member's spouse notifying the
spouse if the member takes the Maximum Allowance pension benefit
(sent Certified mail). Divorced, or ex-spouses, do not need to
be listed.
Line 17 - Spouse's Social Security
Number:
Not required, but will help to expedite
benefit processing at the time of member's death
Line 18 - Spouse's Address:
Only needed if it is different than
the member's mailing address.
Line 19 - Name, Gender and Birth
date of Eligible Dependent Children:
List all dependent children under
age 18, or who are mentally or physically handicapped regardless
of age. Copies of birth certificates, adoption papers, and
medical documentation proving disability are required for each
child listed.
If additional space is needed, the
member may attach additional sheets. If additional sheets
are needed to list dependent children, these also must be notarized.
BACK TO TOP
PART THREE: Designation
of Group Life Insurance Beneficiary
Line
20. Primary Beneficiary(ies):
The primary beneficiary(ies) listed
will receive the member's group life insurance. The coverage amount
varies according to the fund and level of coverage as an active
member.
The following information is needed:
Beneficiary's Name, Address, Date of Birth
and the beneficiary's Relationship to the member (spouse,
daughter, son, father, mother, friend, grandchild, etc.).
If the member chooses multiple primary
beneficiaries and one beneficiary predeceases the member, the
remaining beneficiary(ies) will usually split that beneficiary's
share. Some unusual designations are allowable, but uncommon.
Unless otherwise stated, if there are multiple beneficiaries listed,
they are considered "share and share alike."
Line
21 - Contingent Beneficiary(ies):
In the event all primary beneficiaries
have predeceased the member, the group life insurance benefit
will be paid to all listed contingent beneficiaries on a "share-and-share-alike"
basis, unless otherwise provided for.
In the event all contingent beneficiaries
have also predeceased the member, the group life insurance benefit
will be paid to the member's estate.
The following information is needed: Beneficiary's Name,
Address, Date of Birth and the beneficiary's Relationship
to the member (spouse, daughter, son, father, mother, friend,
grandchild, etc.).
BACK
TO TOP
Member Signature
The member must sign the application.
Instructions for the Employer
Certification for Disability Retirement
Instructions for
Employer Certification for Disability Retirement
Line 1
Please check to appropriate box
denoting the Pension Fund the member belongs to.
Line 2
This is self explanatory. Include
name of the Employee, Job Title (including a copy of the job description),
Social Security Number, Name of employing location, employer address
and phone number.
Type of Disability Retirement: Check
to box that corresponds to the type of Disability Retirement the
member is applying for.
Line 3 - Employee Status
Please check the box that is appropriate.
To determine full-time status, refer to the regulations that pertain
to your location. For example, 35 or 40 hours per week.
Line 4 - Authorized Leave of Absence
Review attendance records to determine
if the member has been on an authorized leave of absence within
the past year. Please check all that apply. This will help the
Division of Pensions to determine the member's final salary.
Line 5 - Unauthorized Leave of
Absence
Please indicate if the member was
out on an unapproved leave and, if so, the duration of the leave.
Line 6a - Is the member currently
on suspension?
It is very important that you answer
this question, even if the answer is "No". If the answer
is "Yes", be sure to include the date of suspension
and any documents that describe the reasons and circumstances
surrounding the suspension. By law, the Division cannot process
a retirement unless and until all information concerning suspensions
are submitted. Be sure to indicate if a suspension is paid or
unpaid.
Line 6b - Is the applicant facing
disciplinary action or indictment?
Again, it is essential that you answer
this question, even if the answer is "No". If the answer
is "Yes", you must attach copies of all documents that
pertain to the disciplinary action or indictment, including preliminary
and final notices of disciplinary action or their equivalents.
Failure to answer questions 6a and
6b will only delay the processing of the applicants retirement.
Line 7 - Was the applicant dismissed?
As with lines 6a and
6b, this question must be answered "yes" or "no".
If yes, you must give the reason and date of dismissal. This may
have a direct bearing on the outcome of the member's application
for retirement.
BACK TO TOP
Line 8 - If the employee is filing
for an Accidental Disability Retirement
Since an Accidental Disability Retirement
is granted only for those who suffer a "Traumatic Event"
during the course of regular job duties, accident reports taken
by the employer are exceptionally important. Please answer the
questions on the basis of official records relating to the accident.
Be sure to include copies of any
pertinent documentation including an accident report, witness
statements, etc.
The question concerning Workers'
Compensation is very important. If a case has been settled
or is still pending, please attach a copy of all documentation
you may on file. This is essential information that may corroborate
the applicant's eligibility for Accidental Disability Retirement,
and may influence the calculation of the member's retirement allowance.
Line 9 - Date employee's service
terminated
This is the last date on which the
employee earned or will earn salary from employment.
Line 10 - Base Salary subject
to pension fund contributions
Last 12 months (10 months if applicable)
of salary must be indicated. Salary should be reported by the
number of months at a given salary, the amount of the monthly
base salary, the beginning and ending dates of that salary and
the total base salary for the period. Salary beyond the last reported
quarter is to be projected to the best of the employer's ability.
Line 11 - Has the member received
an annual salary increase of 10% or more in the last 3 years?
If the answer is yes, the employer
must furnish cause for the increase, with documentation.
The Division may approve the increase, if justifiable, deny the
increased salary, or forward the case to the Board of Trustees
for determination.
Line 12 - Retroactive salary increases
in last three years
A retroactive salary increase can
falsely inflate a member's salary if it is not properly credited
back to the correct dates. Retroactive salaries can also incorrectly
show a single salary increase, when in fact it may cover several
years of increases. The beginning and ending dates should show
for each retroactive increase and the corresponding new
annual base salary.
If the member receives
a retroactive raise after the original Certification has been
sent to the Division, a new Certification must be sent in. The
new Certification should state 'Amended' or 'Revised for Retroactive
Raise.'
BACK TO TOP
Line 13 - Salary Deductions during
final quarters
The employer indicates the actual
and/or projected base salary subject to pension contributions
for the last two quarters preceding the member's termination date.
Also noted in this section are the amounts of actual and/or projected
payroll deductions for: Pension Contributions, Loan Repayment,
Back Deductions (including the number of payments taken), Arrears
(and/or Purchases) deductions, and the Total Pension Deductions
taken (and/or projected to be taken) by the employer and remitted
to the Division for this member.
State employers must attach
a screen print of the member's TREADHOC biweekly certification
with salaries projected until termination date in lieu of completing
Item 11.
Checklist
This is a helpful tool to remind
you which forms and documents to include with the Disability Retirement
Certification.
Enclose a letter addressed to the
Division of Pensions and Benefits stating that, in the employing
authority's opinion, the member is "totally and permanently
disabled" from fulfilling his or her job duties.
Name and Signature of the Superintendent
of State Police
The Superintendent of State Police
must sign this form. This signature must be an original signature
and can not be a stamped signature.
The date signed is helpful in processing
a retirement: when more than one Certification is received, the
Division can ensure that the most recent Certification is used
for processing. Usually more than one Certification is received
when there is a retroactive salary increase, or a correction is
made for erroneous information.
The Medical
Examination by Personal or Treating Physician Form
Instructions for
the Medical Examination By Personal or Treating Physician
Form
- The applicant must complete Part
One and submit the form to the physician(s) who were or
are involved in treating the disabling condition.
- A copy of the job description
may prove helpful to the physician as the assessment for this
form is made.
- If more than one physician's statement
is needed, the applicant may make as many copies as necessary.
- While copies of this form are
permitted, they must be double sided copies of the original.
After completing Part Two,
the physician may forward the form directly to the Division
of Pensions and Benefits at the address listed on the top
of the first page. Or it may be submitted with the Disability
Retirement application by the member.
It is essential that all relevant
medical information be submitted to the Disability Review
Section at the Division of Pensions and Benefits before adequate
determination of eligibility for Disability Retirement can
be made. Any delay in receiving this (or any) form will
only delay processing of the retirement.
The Authorization
for Release of Medical Records
Instructions
for the
"Authorization for Release of Medical Records" Form
Medical records pertaining to any
hospitalization(s) related to the disabling condition must also
be submitted to the Division of Pensions and Benefits.
- If no hospitalization occurred,
then medical examination reports from at least two physicians
must be submitted before a determination of disability can
be made. This form is still required by the Division
of Pensions and Benefits even if there was no hospitalization.
- The member may make as many
copies of this form as necessary in order to obtain records
from more than one hospital.
- The member must submit this
form directly to the hospital requesting the needed records.
- The member also assumes all
responsibility for any charges levied by the hospital for
reproducing and/or forwarding these records to the Division
of Pensions and Benefits.
BACK
TO TOP
|
