State of Connecticut Office of the State Comptroller Retirement & Benefit Services Division Memorandum - Designation of Retirement System-Tier-Plan- Beneficiary

Seal of the Office of the State Comptroller


August 13, 1998


ATTENTION: Personnel and Payroll Officers
SUBJECT: Amended Form CO-931, Designation of Retirement System-Tier-Plan- Beneficiary" & Revised Instructions for Completion of Form CO-931

The Retirement & Benefit Services Division has amended the Form CO-931, "Designation of Retirement System-Tier-Plan-Beneficiary". The CO-931 form was previously revised in June 1997 in conjunction with the implementation of the State Employees Retirement System (SERS) Tier IIA retirement plan effective July 1, 1997. Three notable changes have been made to the form. They are: 1) MULTIPLE EMPLOYMENT has been added to the type of action at the top of the CO-931 form previously labeled as RE-EMPLOYED only, 2) the boxes labeled YES and NO in Block (14) have been reversed and 3) the order of the retirement systems listed in Block (18) has been changed.

Revised CO-931 forms will be available through the State's forms management program within the next thirty days. Until the revised forms are available, please reproduce the attached copy for use for all required CO-931 actions.

Also attached is a revised instruction manual for completion of the CO-931 forms. Please note that this manual has been designed to provide you with all the information needed to complete each block on the newly revised CO-931 form for each of the types of action designated at the top of the form. Effective immediately, please use both the amended CO-931 form and the attached instructions to complete CO-931 forms for all individuals employed by the State of Connecticut with the exception of those individuals employed in the following classifications who are excluded from retirement coverage:

Classification Compensation Class Code
Patient/Inmate Worker 6149
State University Assistants 8105
University Student Laborer 9098
Graduate Assistant 4185
Student Laborer/Student Worker 8152

The Retirement & Benefit Services Division has determined that individuals employed in certain other classifications are also not covered by the provisions of the State Employees Retirement System (SERS). However, completion of a Form CO-931, "Designation of Retirement System-Tier-Plan-Beneficiary," is still required in order to properly identify such individuals. The attached manual provides information on completion of Section II RETIREMENT INFORMATION for individuals employed in classifications excluded from retirement coverage. These additional classifications are:

Classification Compensation Class Code
General Worker - Student 4110
General Worker - Senior Citizen 4111
General Worker - Technical Services 4112
Registered Professional Nurse - Per Diem 0274
Licensed Practical Nurse - Per Diem 0276
Occupational Therapist - Per Diem 4669
Physical Therapist - Per Diem 4670
Physician - Per Diem 4666
Psychiatrist - Per Diem 4667
Psychologist - Per Diem 4668
Speech Pathologist - Per Diem 4671
Cooperative Education Intern 2552
Employment Security Intermittent Interviewer 5021
Maintenance Trainee (S.T.E.P.) 0448

Further, individuals employed at a State university on a Post-Sophomore Fellowship or holding J1 or F1 visas are not eligible to participate in SERS; however a CO-931 form should also be submitted for these individuals. Any questions regarding SERS eligibility should be directed to the Division's Data Base Unit at (860) 702-3515. Please do not refer individual employees to this number.

Completion of a CO-931 form is required for the following personnel actions as designated at the top of the CO-931 form with two exceptions which are listed on page three of this memorandum:

New Employee
Re-employed Employee, Multiple Employment
Agency Transfer
Employee Name and/or Address Change
Beneficiary(ies) Name and/or Address Change
Change in Retirement System Information Only


1) Agencies utilizing the Department of Administrative Services' Automated Personnel System (APS) do not need to submit a CO-931 form in order to initiate a change in an employee's name and/or address. The name and/or address change information is provided to the Retirement & Benefit Services Division through an automated feed from the APS.

2) Part-time lecturers covered by the collective bargaining agreement between the State and the Connecticut State University - American Association of University Professors, Inc. (CSU-AAUP/BOT) who wish to waive their rights to participate in a retirement plan should not fill out a CO-931 form. Instead such individuals must complete a Waiver of Retirement Plan Participation Form.

Please note: You must indicate the type of action submitted on the CO-931 form by checking the appropriate box at the top of the form. Forms with no action designated will be returned to the agency for completion. In addition, all CO-931 forms for re-employed individuals returning to Tier II membership must be accompanied by a Form CO-922, "Retirement Credit - Tier II Members Only" ; CO-931 forms for individuals electing membership in the Alternate Retirement Program must be accompanied by a copy of the TIAA/CREF Group Retirement Annuity Application.

Please keep in mind that the receipt of properly completed CO-931 forms is imperative in order to provide accurate retirement benefit information for annual employee benefit statements and actuarial purposes.

Any questions you have regarding the completion of these forms should be directed to the Retirement & Benefit Services Division, Data Base Unit at (860) 702-3515. Please do not refer individual employees to this number.

Very truly yours,



Steven Weinberger, Director
Retirement & Benefit Services Division

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