State of Connecticut Office of the State Comptroller 2003 EARLY RETIREMENT INCENTIVE PROGRAM memo Attachment F

Attachment "F"

Summary of Forms and Documents Required
to Process Retirement Applications

COMPLETED FORMS REQUIRED

Application for Retirement Benefits: Form CO-898 (Refer to Memorandum dated March 31, 1989, entitled "Retirement Applications".);
Income Payment Election Form (Option): Form CO-899, CO-900, CO-901 or CO-902;
Spouse Waiver of Monthly Survivor Benefits: Form CO-1047 Note: Do not let title of the form confuse you - the CO-1047 must be executed for both married and single employees. (Refer to memorandum dated January 25, 1990, entitled "Form for Spouse Waiver of Monthly Survivor Benefits".) The term "spouse" is also intended to mean a same sex domestic partner who has executed an "Affidavit of Domestic Partnership" (Form CO-1049) with the Division. Refer to Comptroller's Memorandum No. 2000-13, dated March 10, 2000, entitled "Health Care and Pension Benefits for Same Sex Domestic Partners of State Employees and Retirees";
Choice of Health Services after Retirement: Form CO-744 (Refer to memorandum dated May 24, 2002, entitled "Choice of Health Services After Retirement".) Additionally, copies of Medicare Part B cards for both the member and spouse should be provided, as applicable, with the Form CO-744;
Federal W-4P;
State CT-W-4P (Refer to memorandum dated December 26, 1991, entitled "Withholding of Connecticut State Income Tax".);

DOCUMENTATION REQUIRED OF THE EMPLOYEE

Copy of member's birth certificate or acceptable substitutes with affidavit. Please refer to Attachments "G" and "H" for further information.
For married members, (a) copy of spouse's birth certificate or acceptable substitutes with affidavit and (b) copy of marriage certificate.
Where named contingent annuitant is other than a member's spouse, a copy of said annuitant's birth certificate or acceptable substitutes with affidavit.

DOCUMENTATION REQUIRED OF THE AGENCY

For hazardous duty members, copy of roster cards reflecting all positions held in state service which are required to meet twenty year threshold with cover letter listing positions in chronological order. (Refer to Memorandum dated March 25, 1996, entitled "Applications for Hazardous Duty Benefits from SERS").
For members using accrued vacation time to meet the eligibility threshold, copies of attendance records for 2003 reflecting leave balances that serve to bridge minimum service requirements.
For laid-off employees, a copy of the notification of layoff.
A salary history for any member for whom such salary information was not reported to the Automated Personnel System (APS). The history should include salary amounts, reasons for salary changes and the effective dates of such changes.

If any documentation is submitted under separate cover, the member's name, employee number, and date of retirement must appear on each document.