The purpose of this proposed rule amendment is the adoption of one new Division form, 25 revised Division forms, one deletion of a duplicate form listing in rule, 26 corrections to conform to the titles as listed in rule, three corrections to ...

 

DEPARTMENT OF MANAGEMENT SERVICES
Division of Retirement

RULE NO: RULE TITLE
60S-9.001: Approved Forms
PURPOSE AND EFFECT: The purpose of this proposed rule amendment is the adoption of one new Division form, 25 revised Division forms, one deletion of a duplicate form listing in rule, 26 corrections to conform to the titles as listed in rule, three corrections to conform to the descriptions as listed in rule and to update the revision dates of the five State Board of Administration forms adopted by reference.

SUMMARY: The new Division Form is a Bureau of Enrollment and Contributions form:

Form FRS-410 was created for members employed by a law enforcement agency or medical examiner’s office in recognized forensic disciplines who meet certain criteria to make application for Special Risk membership in the Florida Retirement System as provided in Section 121.0515(2)(h), F.S.

The 25 revised Division Forms are:

Revised Bureau of Enrollment and Contribution form:

Form ERQ-1 – This form has been extensively revised. Changes made that are common to each page of the form include the addition of pagination and rule referencing at the bottom left of each page of the form as well as the addition of fields designated for member’s name and SSN also at the bottom of the form. On the first page of form, the redundant rule reference at the top left of the form has been deleted and the Division’s address was updated in the header and the Division’s direct and toll-free telephone numbers were added. The first two paragraphs were consolidated into one with some minor rewording to facilitate reader comprehension and the Division’s telephone numbers and email address were added for ease of member/agency contact. In the fields following; but prior to Question 1, Agency Federal Identification Number field was deleted as such is not necessary. Inverted the order of the first two lines of fields and slightly re-titled the fields requesting Worker’s name and SSN to ensure proper form completion. On line three of the fields, added section for user to indicate who is completing the form and added titles to the date fields for proper form completion.

Question 1 – technical correction changed ex. to e.g.

Question 2 through 5, 7 through 16 and 20 through 23 – were put in present tense and minor rewording changes were made to facilitate reader comprehension. Question 2 – segregated existing paragraph (a) into a second paragraph to facilitate reader comprehension and proper form completion and expanded line of questioning to include a fourth paragraph. Question 3 added a parenthetical instructional statement to paragraph (a) to facilitate proper form completion. Question 4 expanded line of questioning from 4 paragraphs to 9. Question 5. deletes paragraph (b) and expounded upon line of questioning to include paragraph (e). Question 7 – Segregated paragraphs (a) as well as (b) into 2 paragraphs each therein expanding the number of paragraphs to 5 for purposes of proper form completion. Question 9 – Deleted paragraph (c). Question 10 – Added paragraph (b). Question 13 – Deleted follow up explanation if response was affirmative. Question 14- Deleted the option box “unknown”. Question 15 - Deleted the option box “unknown” and re-titled remaining option boxes to facilitate proper form completion. Question 17 – Deleted paragraph (b). Question 19 – Added the option box, “own name” and re-titled the remaining option boxes to facilitate proper form completion. The “Remarks” section of the form was deleted. Minor rewording of the “certification statement” was made to facilitate user understanding and a field for signature, email and fax were added.

10 Revised Bureau of Retirement Calculation Forms:

Form FR-11 – Deleted redundant rule reference at top left of each page of document, deleted obsolete SUNCOM telephone number from header of the instructional page and replaced it with the Division’s new toll free telephone number. Division’s direct and toll-free numbers were added to the header of the form page. Changes specific to the Instructional page follow:

In requirement number 1: Deleted the text “both jobs” from end of last sentence and replaced it with the text “from all positions” to match wording in statute as provided in Section 121.021(39), F.S.

In requirement number 3: Replaced the word next with attached and added the title of the attachment, “What Retirement Option Should You Choose.” to facilitate reader’s understanding.

In requirement number 4: As provided in Internal Revenue Code, added the following clarifying statement:

“You may rollover funds from a qualified plan (IRA, deferred compensation, etc.) to pay the amount due. Form PRO-1, Pretax Direct Rollover must be received with the payment. Rollovers cannot be made for upgraded service.”

In requirement number 5: Technical correction made wherein comma and parentheses was removed from second sentence and parentheses was placed around the text, “except for g.”

On the form page of the FR-11, deleted the redundant word “additional” from the second sentence in the paragraph just above member signature line and reformatted Notary Block.

Form MF-1 – Deleted redundant rule reference from the upper-left of form. The Division’s direct and toll-free telephone numbers were added to the header of each page. Form changes were made as follows:

1. In the first sentence, deleted the text “back of this form” and replaced it with the text “next page.” This was a technical correction as the back of the form is not utilized for print.

2. Deleted redundant sentence just below Member Name and Member SSN, as it reiterates the sentence referenced in change 1 above. Deleted sentence read:

Prior to completing, please read the back of this form for the requirements for claiming military service under the Florida Retirement System.

3. Inverted order of Signature line and the “Check One” option line and moved and reworded the statement in parentheses between these two lines to just above them. The statement read:

(If member is deceased, beneficiary signature and beneficiary SSN. Sign in the presence of a notary.)

To facilitate reader comprehension, the parentheses were removed and the statement was amended to read:

This section must be signed in the presence of a notary. Beneficiary signature and beneficiary SSN is needed if member is deceased

4. Reformatted the Notary Block.

Instructional page changes:

1. Deleted the references to the Mexican War and World War I due to the length of time that has passed since these events took place.

2. Added a sentence to the paragraph following section 4 of the instructional page, to advise members of the federal website to obtain the form to request military papers.

3. Changed the classification of pagination from an Instructional page to an Informational page.

Form MF-2 – Deleted the text, “of Section 121.1115, F.S.,” from title of form for simplification of form title and for consistency in titling with other Division forms (statutory reference remains in text). The redundant rule reference in the upper left corner of form was deleted. In the first sentence of form, a technical correction was made wherein the parentheses were removed following “1.” and “2.” In statement 1, the last word of the sentence was changed from “system” to “plan” to facilitate reader comprehension. In sections 1 and 2, inverted the order of the “Signature” line and the “Check One” option line to ensure proper form completion and moved and reworded the statement in parentheses between these two lines to just above them to facilitate reader comprehension. The statement read:

(If member is deceased, beneficiary signature and beneficiary SSN. Sign in the presence of a notary.)

To facilitate reader comprehension, the parentheses were removed and the statement was amended to read:

This section must be signed in the presence of a notary. Beneficiary signature and beneficiary SSN is needed if member is deceased

The Notary Block was reformatted.

Form FRS-11o – Redundant rule reference was deleted from the upper-left of form. The Division’s direct and toll-free telephone numbers were added to the header. In the second sentence of the Option 2 section, replaced “120 monthly payments” following retirement references with “10-year period” to reflect references in Section 121.091(6)(a)2., F.S., and to facilitate reader comprehension. This change resulted in minor rewording of text. To facilitate proper form completion in the Spousal Acknowledgement block, reworded the sentence, “If yes, your spouse must complete the Spousal Acknowledgement.” to read “If yes, your spouse must sign below”. To facilitate reader comprehension in the second sentence of both the Option 3 and 4 explanations, the following text was added in parentheses following joint annuitant, “spouse or financial dependent.” In the paragraph preceding the Member Signature line, deleted the word “additional” following the word “add” as it was redundant.

Form FST-11o – Redundant rule reference was deleted from the upper-left of form. Division’s direct and toll-free telephone numbers were added to the header. Following the first sentence on the form, added the following sentence to facilitate proper form completion:

“Please read the option explanations below before completing your selection.”

In the paragraph preceding the Member Signature line, deleted the word “additional” following the word “add” because it was redundant.

Form DP-ELE – Redundant rule reference was deleted from the upper-left of form. Division’s direct and toll-free telephone numbers were added to the header and the Notary Block was reformatted. In the 2nd paragraph of text (in the section titled Resignation From Employment to Participate in the DROP) deleted the redundant word “additional”. Added the phrase “or elect the Investment Plan,” as is provided in Section 121.4501(2), F.S. Added “/01/” to the DROP begin date day format to ensure proper form completion as provided in Section 121.091(13)(c)3., F.S.

Form DP-11 – Redundant rule reference was deleted from the upper-left of form. Division’s direct and toll-free telephone numbers were added to the header and the Notary Block was reformatted. In the 2nd paragraph of form, added the text “Chapter 121, Florida Statutes” for user clarification and deleted the word “additional” because it was redundant. Added “or elect the Investment Plan,” to the list of restrictions a member cannot do after retiring to participate in the DROP as provided in Section 121.091(13)(c), F.S. In the Beneficiary Designation section of the form, added a second sentence instructing use of the Form FST-12 when designating more than one primary beneficiary to facilitate proper form usage.

Form DT-11 – Redundant rule reference was deleted from the upper-left of pages and the Division’s direct and toll-free telephone numbers were added to the header.

Changes to the Instructional page:

Item # 3 – Reworded 2nd sentence to facilitate reader comprehension.

Item# 4 – As member may use a direct rollover or trustee to trustee transfer of funds to the Florida Retirement System Pension Plan for the purchase of prior service pursuant to the provisions of Section 112.215 (13), F.S., after enabling federal legislation in the “Economic Growth and Tax Reconciliation Act of 2001” became effective January 1, 2002, the following three sentences were added to facilitate reader comprehension.

You may roll over funds from a qualified plan (IRS, deferred compensation, etc.) to pay the amount due. Form PRO-1, Pretax Direct Rollover, must be received with the payment. Rollovers cannot be made for upgraded service.

Item #5 – Technical correction made to the last sentence. Deleted comma after the word “following” and moved the opening parenthesis before the word “except.”

Item #7 – Added clarifying statement, “…; otherwise complete the Beneficiary Designation section of Form DT-11.

Changes to the form page:

In the Beneficiary Designation section, deleted the word “additional” following the “add” because it was redundant. Added “or elect the Investment Plan”, to the list of restrictions since this is one of the things a member cannot do after retiring to participate in the DROP as provided in stipulated in Section 121.091(13)(c), F.S. In the Beneficiary Designation section of form, added a second sentence instructing the use of the Form FST-12 when designating more than one primary beneficiary to facilitate proper form usage. Notary Block was reformatted. In the For educational agencies only section changed statutory reference from Section 228.041(9)(a)-(d) to Section 1012.01(2), F.S., as a result of Chapter 2002-387 of Florida Laws and as provided in Section 121.091(13), F.S.

Form DS-11 – Each page of document was paginated along with rule reference in the lower left of form. Redundant rule reference was deleted from the upper-left of pages and the Division’s direct and toll-free telephone numbers were added to the header.

Changes to instruction page:

Item #3 – Changed reference to option explanation location from “back of this page” to “attached page.”

Item #4 – Since a member may use a direct rollover or trustee to trustee transfer of funds to the Florida Retirement System Pension Plan for the purchase of prior service pursuant to the provisions of Section 112.215(13), F.S., after enabling federal legislation in the “Economic Growth and Tax Reconciliation Act of 2001” became effective January 1, 2002, the following three sentences were added for user clarification:.

You may roll over funds from a qualified plan (IRS, deferred compensation, etc.) to pay the amount due. Form PRO-1, Pretax Direct Rollover, must be received with the payment. Rollovers cannot be made for upgraded service.

Item #5 – Technical correction made to the last sentence. Deleted comma after the word “following” and moved the opening parenthesis before the word “except.”

Item #7 – changed text to read “…of Form DS-11” instead of “…of this form” for user clarification.

Changes to the form page:

In the Beneficiary Designation section, deleted the word “additional” following the “add” as it was redundant. Added “or elect the Investment Plan,” to the list of restrictions because this is one of the things a member cannot do after retiring to participate in the DROP as provided in stipulated in Section 121.091(13)(c), F.S. In the Beneficiary Designation section of the form, added a second sentence instructing the use of the Form FST-12 when designating more than one primary beneficiary. Notary Block was reformatted.

Form PRO-1 – Removed redundant rule reference from the upper-left of form and deleted Division’s obsolete SUNCOM telephone number from the header and replaced it with the Division’s toll-free number. Added an instructional paragraph (preceding section I) to ensure proper completion of form by the user. In section III, added 401k as an account type per change in Internal Revenue Code making such account type a qualified plan.

The 14 Revised Bureau of Benefit Payment Forms:

Form FR-13 – Deleted telephone numbers in text of page 1 of instructions and added Division’s direct and toll-free telephone numbers to header. Updated email address in page 1 of instructions, removed redundant rule reference in the upper-left of form, added form title to 2nd page of instruction. Deleted text “or your immediate supervisor” from the end of the sentence beginning with “Form FR-13a,…” in page 1 of instructions. Notary Block reformatted on page 2 of form.

Form FR-13a – Added Division’s direct and toll-free telephone numbers and updated Division address in header, paginated form and added rule reference in lower left of form in accordance with Section 120.55(1)(a)4., F.S., and removed redundant rule reference from the upper-left corner of form. Form title added to second page of form. In the lower quadrant of the 2nd page of form, deleted “Employer Signature” and replaced with “Authorized Signature.”

Form FR-13b – Added Division’s direct and toll-free telephone numbers and updated Division address in header, paginated form and added rule reference in lower left of form in accordance with the Section 120.55(1)(a)4., F.S., and removed redundant rule reference from the upper-left corner of form. Form title added to second page of form. Adds the following sentence to the Physician’s Statement section of page 1 “However, office notes CANNOT be submitted in lieu of properly completing page two of this form.”

Form FR-13e – Added Division’s direct and toll-free telephone numbers and updated Division address in header, paginated form and added rule reference in the lower left of form in accordance with the Section 120.55(1)(a)4., F.S., and removed redundant rule reference from the upper-left corner of form. Form title added to second page of form and corrects outdated statute reference in Section A of page 1 from Section 121.091(4)(e)1. to 121.091(4)(h)1. of the Florida Statutes.

Form FR-13f – Added Division’s direct and toll-free telephone numbers and updated Division address in header, paginated form and added rule reference in the lower left of form in accordance with the Section 120.55(1)(a)4., F.S., and removed redundant rule reference from the upper-left corner of form. Form title added to second page of form. Title of section 2, “Physical Impairment,” amended to read “Physical and/or Mental Impairment.”

Form HIS-1 – Added Toll-free telephone number to header and bottom right of form, updated email address, removed redundant rule reference from the upper left of form, replaced the word “section” in the second sentence of the form with the word “box” to clarify proper form completion. In Section A of form, expanded title of section to more accurately describe who should complete the section, expanded text of certifying statement by adding the word “required” to the first sentence and adding the word “former” to the last sentence and differentiated contacts for local and state agencies necessary with the introduction of PeopleFirst . Section B title amended to reflect to more accurately describe who should complete the section as was necessary with the introduction of PeopleFirst. Section C, title amended to reflect to more accurately describe who should complete the section. Section D, title amended to reflect to more accurately describe who should complete the section. On instruction page, deleted title of information page and replaced with form title in header to correspond with form page, added Florida State Community College System Optional Retirement Programs to the list of those not eligible for the Health Insurance Subsidy as provided in Section 112.363 and 121.051(2)(c), F.S., and added the word “completed” to the first sentence of the section titled “Retroactive HIS Payments:” to facilitate reader comprehension.

Form DIS-1 – Added Division’s direct and toll-free telephone numbers to the header, removed redundant rule reference from the upper-left of form, updated statutory reference in text of form from Section 689.21 to Chapter 739, F.S., and reformatted Notary Block. On Instruction page of document, added the text “of the Disclaimer” to the second sentence of the first paragraph for clarification and in the last paragraph in the first sentence made a technical correction and changed “that” Florida to “than” Florida.

Form DP-Term – Added toll-free telephone number to header, paginated form and added rule reference in the lower left of form in accordance with the Section 120.55(1)(a)4., F.S., and removed redundant rule reference from the upper-left corner of form, adds the phrase, “This is to acknowledge that” preceding existing sentence, “I will terminate or have…,” and added the sentence, “This further acknowledges that I have read and understand the above statements.” Notary Block reformatted.

Form DP-PAYT – Added toll-free telephone number to header, paginated form and added rule reference in the lower left of form in accordance with the Section 120.55(1)(a)4., F.S., and removed redundant rule reference from the upper-left corner of form, Notary Block reformatted and the acknowledgement statement, “This is to acknowledge that I have made a selection above and that I have received a copy of Special Notice Regarding Plan Payments” has been added to the Notary Block just above payee signature, and  added 401(k) as an account type to be selected in the section of the form completed by the custodian of the eligible retirement plan as provided in Internal Revenue Code.

Form DP-12 – Deleted telephone number from text of form and added direct and toll-free telephone numbers to the header of the form. Deleted the words “of Retirement at,” which preceded the deleted telephone number in text. Removed redundant rule reference from upper-left of form, deleted the third paragraph commencing with “Any benefits due after the month of death…,” as this was never intended to be included on the form. Notary Block was reformatted.

Form DIS-2 – Added toll-free telephone number to header, deleted redundant rule reference from the upper-left of form, updated Florida Statute reference from Section 689.21 to Chapter 739, F.S., reformatted Notary Block. On instruction page of document, added the text “of the Disclaimer” to the second sentence of the first paragraph for clarification and in the last paragraph in the first sentence made a technical correction and changed “that” Florida to “than” Florida.

Form DIS-3 – Added toll-free telephone number to header, deleted redundant rule reference from the upper-left of form, updated Florida Statute reference from Section 689.21 to Chapter 739, F.S., reformatted Notary Block. On Instruction page of document, added the text “of the Disclaimer” to the second sentence of the first paragraph for clarification and in the last paragraph in the first sentence made a technical correction and changed “that” Florida to “than” Florida.

Form SRA-1 – Added Division’s direct and toll-free telephone numbers and updated Division address in header, paginated form and added rule reference in the lower left of form in accordance with the Section 120.55(1)(a)4., F.S., and removed redundant rule reference from the upper-left corner of form. Adds additional clarification statement to be acknowledged by signer which reads, “I further understand that if the State Retirement Commission or the Court does not approve my disability retirement claim, my decision to receive service retirement cannot be revoked, and my retirement option selected cannot be changed.” Inverted order of applicant name and address and reformatted Notary Block.

Form PR-13 – Deleted telephone numbers in text of page 1 of instructions and added Division’s direct and toll-free telephone numbers to header. Updated email address on page 1 of instructions, removed redundant rule reference in the upper-left of form, added form title to 2nd page of instruction, deleted “or your immediate supervisor” from the end of the sentence beginning with “Form FR-13a,…” on page 1 of instructions.  Notary Block reformatted on page 2 of form.

The deleted duplicate form listing in Rule:

Form DP-EXT is correctly listed as a Bureau of Calculations form in paragraph 60S‑9.001(2)(v), F.A.C. The erroneous duplicate listing in paragraph 60S-9.001(3)(rr), F.A.C., as a Bureau of Benefit Payments form has been deleted.

The 26 corrections to Form Titles in Rule are:

1 Bureau of Enrollment and Contributions form

Form BLE-1 – corrected rule to include Pension Plan in title of form as is reflected in the title of the form.

1 Bureau of Retirement Calculations form

Form SR-11 – Replaced the acronym SCOERS in title of the form in rule with the full name of the retirement system as is reflected in the title of the form itself.

24 Bureau of Benefit Payment forms

Forms TR-13, TR-13a, TR-13b, TR-13e and TR-13f – Replaced the acronym TRS in title of the form in rule with the full name of the retirement system as is reflected in the title of the form itself.

Forms SR-13, SR-13a SR-13b, SR-13e and SR-13f – Replaced the acronym SCOERS in title of the form in rule with the full name of the retirement system as is reflected in the title of the form itself.

Forms FRS-M-81, AAPS, SRF-2, SRF-3, SVF-1, SVF‑2, JA-NUL, FR-30b, DP-Joint, Rollover, SB-13b, FST-11so2, and DP-TEOC all added Pension Plan to title of form in rule to match the title of promulgated form.

Form DROLL – corrected form title in rule to read Florida Retirement System Pension Plan Beneficiary Direct Rollover Election Form to match the title of promulgated form.

The 3 corrections to form descriptions in rule are:

1 Bureau of Enrollment form

Form SMSD-1 – Changed form description in rule to match form. Description listed an information page in error. It should have been listed as a page of instruction.

1 Bureau of Retirement Calculations form

Form FR-28 – Changed form description in rule to coincide with that of form. Description listed an instruction page in error. It should have been listed as an information page.

1 Bureau of Benefit Payments form

Form TR-11c – Changed form description in rule to match that of form. Description listed an instruction page in error. It should have been listed as an information page.

The 5 State Board of Administration forms with updated revision dates are:

•              Form OCC-1 – Revised 10/06

•              Form OCC-2 – Revised 10/06

•              Form SMS-1 – Revised 10/06

•              Form SMS-3 – Revised 10/06

•              Form EOC-1 – Revised 10/06

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COST: No State of Estimated Regulatory Cost was prepared.

Any person who wishes to provide information regarding the statement of estimated costs, or to provide a proposal for a lower regulatory cost alternative must do so in writing within 21 days of this notice.

SPECIFIC AUTHORITY: 121.031 FS.
LAW IMPLEMENTED: 1.01, 112.215, 112.361, 112.363, 120.55, 121.011, 121.015, 121.021, 121.031(2), 121.051, 121.0515, 121.081, 121.091, 121.111, 121.1115, 121.1122, 121.121, 121.125, 121.4501, 121.591, 122.08, 122.09, 215.28, 238.05, 238.06, 238.07, 689.21, 1012.01 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW.

DATE AND TIME: June 28, 2007,  10:00 a.m. EST

PLACE: Department of Management Services, Division of Retirement, 1317 Winewood Blvd., Bldg. 8, Conference Room 208, Tallahassee FL 32399-1560, (850)488‑5706

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/hearing/meeting is asked to advise the agency at least 48 hours before the workshop/hearing/meeting by contacting Richard Clifford at [phone], or Toll Free 877-1737. If you are hearing or speech impaired, please contact the agency by calling  [phone].
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Garry Green, Operations and Management Consultant Manager, Department of Management Services, Division of Retirement, 1317 Winewood Blvd., Bldg. 8, Tallahassee FL 32399-1560, [phone]

THE FULL TEXT OF THE PROPOSED RULE IS:

60S-9.001 Approved Forms.

The following is a list of the forms utilized by the Division of Retirement in its dealings with the public, which are hereby incorporated by reference into these rules. A copy of these forms may be obtained from the Division’s website (http://frs.myflorida.com) or by writing to the Division of Retirement, P. O. Box 9000, Tallahassee, Florida 32315-9000., You may also call the Division to request a copy of these forms or by calling [phone] 488-5540. If calling from outside the Tallahassee calling area, you may call the Division toll-free at [phone].

(1)(a)  Bureau of Enrollment and Contributions.

 

FORM NO./ REVISION DATE	TITLE/DESCRIPTION
1. BEN-001 (Rev. 6/04)	Florida Retirement System Pension Plan Beneficiary Designation Form Active Members Only – a one-page form.
2. FRS-400 (Rev. 4/00)	Florida Retirement System Application for Special Risk Membership Law Enforcement/Correctional Officers – a one-page form.
3. FRS-401 (Rev. 7/99)	Florida Retirement System Special Risk Credit for Past Service – a one-page form.
4. FRS-402 (Rev. 10/01)	Florida Retirement System Application for Special Risk Equivalent Credit – a one‑page form.
5. FRS-404 (Rev. 11/02)	Florida Retirement System Application for Special Risk Administrative Support Class – a one-page form.
6. FRS-405 (Rev. 10/03)	Florida Retirement System Application for Special Risk Membership Firefighters/Paramedics/EMTs – a one-page form.
7. ERQ-1 (Rev. 8/06) (Rev. 8/99)	Florida Retirement System Pension Plan Employment Relationship Questionnaire for Retirees Within the 2nd – 12th Months – a five-page form. Florida Retirement System Ballot for Member of an Existing Retirement System– a three-page form.
8. BLE-1 (8/99)	Florida Retirement System Pension Plan Ballot for Member of an Existing Retirement System – a one-page form.
9. SMSD-1 (Rev. 8/00)	Florida Retirement System Senior Management Service Class Designated Position Form – a two-page document consisting of one page of instruction information and a one-page form.
10. FRS-410 (08/05)	Florida Retirement System Application for Special Risk Class Membership Forensic Discipline – a one-page form.

 

(b) State Board of Administration – Enrollment and Election forms.

FORM NO./ REVISION DATE	TITLE/DESCRIPTION
1. OCC-1 (Rev. 10-06) (07/04)	Community College Optional Retirement Program (CCORP) Retirement Plan Choice Form for Eligible Employees.
2. OCC-2 (Rev. 10-06) (11/04)	Retirement Plan Conversion Form for Community College Optional Retirement Program (CCORP) Members.
3. SMS-1 (Rev. 10-06) (Rev. 07/04)	State Senior Management Service Employees Retirement Plan Enrollment Form.
4. SMS-3 (Rev. 10-06) (Rev. 07/04)	Local Senior Management Service Employees Retirement Plan Enrollment Form.
5. EOC-1 (Rev. 10-06) (Rev.  07/04)	Elected Officers’ Class Employees Retirement Plan Enrollment Form.

 

(2) Bureau of Retirement Calculations.

FORM NO./ REVISION DATE	TITLE/DESCRIPTION
(a) FR-9 (Rev. 6/04)	Florida Retirement System Pension Plan Information Request – a one-page Form.
(b) FR-11 (Rev. 7/06) (Rev. 6/04)	Florida Retirement System Pension Plan Application for Service Retirement – a two-page document consisting of one page of instruction and a one-page form.
(c) SR-11 (Rev. 5/87)	State and County Officers’ and Employees’ Retirement System SCOERS Application for Service Retirement – a two-page document consisting of one page of instruction and a one-page form.
(d) TR-11 (Rev. 7/99)	Teachers’ Retirement System Application for Service Retirement – a two-page document consisting of one page of instruction and a one-page form.
(e) FR-28 (Rev. 6/04)	Division of Retirement Pension Plan Application to Purchase Retirement Credit for a Pension Plan Leave of Absence – a two-page document consisting of one page of information instruction and a one-page form.
(f) MF-1 (Rev. 7/06) (Rev. 7/04)	Florida Retirement System Pension Plan Statement of Military Eligibility – a two-page document consisting of one page of information instruction and a one-page form.
(g) TR-4 (Rev. 4/99)	Florida Retirement System Verification of Out-Of-State Teaching Service – a two-page document consisting of one page of instruction and a one-page form.
(h) OSE-1 (Rev. 7/99)	Florida Retirement System Eligibility for In-State or Out-Of-State Service – a one-page form.
(i) WC-1 (Rev. 7/99)	Florida Retirement System Certification of Workers’ Compensation – a one-page form.
(j) FC-1 (Rev. 7/04)	Florida Retirement System Pension Plan Salary Certification – a two-page document consisting of one page of instruction and a one-page form.
(k) MF-2 (Rev. 7/06) (Rev. 7/04)	Florida Retirement System Pension Plan Statement of Military Eligibility to Purchase Military Service Under the Out-of-State Provisions of Section 121.1115, F.S. – a two-page document consisting of one-page of information and a one-page form a one-page form.
(l) FR-23 (Rev. 5/05)	Florida Retirement System Pension Plan Notification of Reemployment or Suspension of Retirement Benefits – a one-page form.
(m) FR-23a (Rev. 5/05)	Florida Retirement System Pension Plan Application to Reactivate Retirement Benefits – a one-page form.
(n) FR-30 (Rev. 7/04)	Florida Retirement System Pension Plan Verification for In-State or Out-of-State Service Credit – a three-page document consisting of one page of instruction and a two-page form.
(o) FR-30a (Rev. 7/04)	Florida Retirement System Pension Plan Out-of-State Employer Request – a one-page form
(p) FRS-11o (Rev. 7/06) (Rev. 7/04)	Florida Retirement System Pension Plan Option Selection for FRS Members – a one-page form.
(q) FST-11o (Rev. 7/06) (Rev. 7/04)	Florida Retirement System Pension Plan Option Selection for TRS and SCOERS Members – a one-page form.
(r) DP-ELE (Rev. 7/06) (Rev. 7/04)	Florida Retirement System Pension Plan Notice of Election to Participate in the Deferred Retirement Option Program (DROP) and Resignation of Employment – a two-page document with one page of information instruction and a one-page form.
(s) DP-11 (Rev. 7/06) (Rev. 7/04)	Florida Retirement System Pension Plan Application for Service Retirement and the Deferred Retirement Option Program (DROP) – a two three-page form consisting of one page two pages of instruction and a one-page form.
(t) DT-11 (Rev. 7/06) (Rev. 9/01)	Teachers’ Retirement System Application for Service Retirement and the Deferred Retirement Option Program (DROP) – a two-page three-page document consisting of one page two pages of instruction information and a one-page form.
(u) DS-11 (Rev. 7/06) (Rev. 7/99)	State and County Officers’ and Employees’ Retirement System Application for Service Retirement and the Deferred Retirement Option Program (DROP) – a two-page three-page document consisting of one page two pages of instruction information and a one-page form.
(v) DP-EXT (5/05)	Florida Retirement System Pension Plan Extension of Deferred Retirement Option Program (DROP) for Specified K-12 Instructional Personnel – a one-page form.
(w) PRO-1 (Rev. 7/06) (12/02)	Florida Retirement System Pension Plan (401(a) Plan) Pretax Direct Rollover/Transfer Form – a one-page form.
(x) HIS-IP (7/04)	Florida Retirement System (FRS) Application for Health Insurance Subsidy for Investment Plan Members – a two-page document consisting of one page of instruction and a one-page form.
(y) HIS IP-2 (7/04)	Florida Retirement System Health Insurance Subsidy Certification for Investment Plan Members – a one-page form.
(z) SA-1 (5/00)	Division of Retirement Spousal Acknowledgement – a one-page form.

 

(3) Bureau of Benefit Payments.

FORM NO./ REVISION DATE	TITLE/DESCRIPTION
(a) FR-13 (Rev. 7/06) (Rev. 2/04)	Florida Retirement System Pension Plan Application for Disability Retirement – a four-page document consisting of two pages of instruction and a two-page form.
(b) FR-13a (Rev. 7/06) (Rev. 7/99)	Florida Retirement System Statement of Disability by Employer – a two-page form.
(c) FR-13b (Rev. 6/06) (Rev. 7/99)	Florida Retirement System Physician’s Report of Disability a two-page form.
(d) TR-13 (Rev. 10/86)	Teachers’ Retirement System of Florida TRS Application for Disability Retirement – a one-page form.
(e) TR-13a (Rev. 10/86)	Teachers’ Retirement System of Florida Member’s Statement of Disability – a one-page form.
(f) TR-13b (Rev. 10/86)	Teachers’ Retirement System of Florida Physician’s Report of Disability – a one‑page form.
(g) SR-13 (Rev. 9/71)	State and County Officers’ and Employees’ Retirement System SCOERS Application for Disability Retirement – a one-page form.
(h) SR-13a (Rev. 9/71)	State and County Officers’ and Employees’ Retirement System SCOERS Member’s Statement of Disability – a one-page form.
(i) SR-13b (Rev. 9/71)	State and County Officers’ and Employees’ Retirement System SCOERS Physician’s Report of Disability – a one-page form.
(j) FR-13e (Rev. 7/06) (Rev. 7/99)	Florida Retirement System FRS Retiree’s Report of Continuing Disability – a two-page form.
(k) FR-13f (Rev. 7/06) (Rev. 7/99)	Florida Retirement System FRS Physician’s Report of Reexamination – a two-page form.
(l) TR-13e (Rev. 2/88)	Teachers’ Retirement System TRS Retiree’s Report of Continuing Disability – a four page form.
(m) TR-13f (Rev. 7/81)	Teachers’ Retirement System TRS Physician’s Report of Reexamination – a four-page form.
(n) SR-13e (10/86)	State and County Officers’ and Employees’ Retirement System SCOERS Retiree’s Report of Continuing Disability – a four-page form.
(o) SR-13f (Rev. 7/81)	State and County Officers’ and Employees’ Retirement System SCOERS Physician’s Report of Reexamination – a four-page form.
(p) FRS-M81 (Rev. 7/01)	Florida Retirement System Pension Plan Request for Refund – a one-page form.
(q) HIS-1 (Rev. 7/05) (Rev. 7/02)	Florida Retirement System Pension Plan Health Insurance Subsidy Certification Form – a two-page document consisting of one page of instruction and a one-page form.
(r) FST-12 (Rev. 12/02)	Florida Retirement System Pension Plan Beneficiary Designation Form (Retired Members Only) – a one-page form.
(s) JA-1 (Rev. 12/02)	Florida Retirement System Pension Plan Change of Joint Annuitant Form (Retired Members Only) – a one-page form.
(t) AAPS (Rev. 8/00)	Florida Retirement System Pension Plan Affidavit Attesting to Payee Status Military Eligibility – a one-page form.
(u) FST-11b (Rev. 12/02)	Florida Retirement System Pension Plan Application of Beneficiary for Monthly Retirement Benefits – a one-page form.
(v) FST-11g (Rev. 12/02)	Florida Retirement System Pension Plan Application of Beneficiary for Benefit Payment – a one-page form.
(w) TR-11c (Rev. 12/02)	Teachers Retirement System Application for Survivor Benefits – a two-page document consisting of one page of information instruction and a one-page form.
(x) SRF-2 (Rev. 7/99)	Florida Retirement System Pension Plan Student Report Form – a one-page form.
(y) SRF-3 (Rev. 7/99)	Florida Retirement System Pension Plan Authorization for Release of Information – a one-page form.
(z) SVF-1 (Rev. 7/99)	Florida Retirement System Pension Plan Student Verification of Enrollment by Institution – a one-page form.
(aa) SVF-2 (Rev. 7/99)	Florida Retirement System Pension Plan Affidavit Attesting to Eligibility – a one-page form.
(bb) DIS-1 (Rev. 4/06) (Rev. 12/02)	Florida Retirement System Pension Plan Disclaimer of Benefits – a two-page document consisting of one page of instruction and a one-page form.
(cc) JA-NUL (Rev. 7/99)	Florida Retirement System Pension Plan Joint Annuitant Nullification Form – a one-page form.
(dd) FR-30b (Rev. 7/99)	Florida Retirement System Pension Plan Verification for In-State or Out-of-State Service Credit – a two-page form.
(ee) DP-TERM (Rev. 6/06) (Rev. 8/01)	Florida Retirement System Pension Plan Deferred Retirement Option Program (DROP) Termination Notification – a one-page form.
(ff) DP-PAYT (Rev. 3/03) (Rev. 10/01)	Florida Retirement System Pension Plan Deferred Retirement Option Program (DROP) Selected Payout Method – a one-page form.
(gg) DP-JOINT (Rev. 9/99)	Florida Retirement System Pension Plan Deferred Retirement Option Program (DROP) Joint Annuitant Verification – a one-page form.
(hh) Rollover (Rev. 7/01)	Florida Retirement System Pension Plan Direct Rollover Election Form – a one-page form.
(ii) DP-12 (Rev. 2/06) (Rev. 9/02)	Florida Retirement System Pension Plan Beneficiary Designation Form for the Alternate Payee of a DROP Participant – a one-page form.
(jj) SB-13b (Rev. 3/01)	Florida Retirement System Pension Plan SCOERS Physician’s Report – a two-page form.
(kk) FST-11so2 (Rev. 12/02)	Florida Retirement System Pension Plan Application for Survivor Benefits – a one-page form.
(ll) DP-TEOC (9/01)	Florida Retirement System Pension Plan Deferred Retirement Option Program (DROP) Elected Officers’ Termination Notification – a one-page form.
(mm) DROLL (1/02)	Florida Retirement System Pension Plan Beneficiary Direct Rollover Election Form – a one-page form.
(nn) DIS-2 (Rev. 4/06) (8/03)	Florida Retirement System Pension Plan Disclaimer of Benefits – a two-page document consisting of one page of instruction and a one-page form.
(oo) DIS-3 (Rev. 4/06) (8/03)	Florida Retirement System Pension Plan Disclaimer of Benefits – a two-page document consisting of one page of instruction and a one-page form.
(pp) DP-VOID (4/03)	Florida Retirement System Pension Plan Deferred Retirement Option Program (DROP) Void Form – a one-page form.
(qq) SRA-1 (Rev. 12/04) (Rev. 7/04)	Florida Retirement System Pension Plan Service Retirement Agreement – a one-page form.
(rr) DP-EXT (5/05) (see 60S‑9.001(2)(v.)	Florida Retirement System Pension Plan Extension of Deferred Retirement Option Program (DROP) for Specified K-12 Instructional Personnel – a one-page form.
(rr)(ss) PR-13 (Rev. 7/06) (7/04)	Florida Retirement System Investment Plan Application for Disability Retirement – a four-page form consisting of two pages of instruction and a two-page form.
(ss)(tt) PR-11o (7/04)	Florida Retirement System Investment Plan Option Selection for FRS Members – a one-page form.

 

(4) Administration.

FORM NO./ REVISION DATE	TITLE
(a) SAPS (Rev. 10/02)	Florida Retirement System Statement Attesting to Payee Status – a one-page form.

 

Specific Authority 121.031 FS. Law Implemented 1.01, 112.215, 112.361, 112.363, 120.55, 121.011, 121.015, 122.021, 121.031(2), 121.051, 121.0515, 121.081, 121.091, 121.111, 121.115, 121.1122, 121.121, 121.125, 121.4501, 121.591, 122.08, 122.09, 215.28, 238.05, 238.06, 238.07, 689.21, 1012.01 FS. History–New 9-9-82, Amended 2-6-84, 11-6-84, 4-17-85, Formerly 22B-9.01, Amended 6-4-86, 12-5-90, Formerly 22B-9.001, Amended 1-4-93, 1-18-94, 4-26-94, 1-10-95, 11-2-95, 12-28-95, 3-12-96, 12-16-97, 10-14-98, 4-26-99, 1-24-00, 12-19-00, 2-6-01, 3-18-02, 10-23-05,_________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Garry Green, Operations and Management Consultant Manager, Department of Management Services, Division of Retirement, 1317 Winewood Blvd., Bldg. 8, Tallahassee, FL 32399-1560, [phone]
NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: Sarabeth Snuggs, Division Director, Department of Management Service, Division of Retirement, 1317 Winewood Blvd., Bldg 8, Tallahassee FL 32399-1560, [phone]
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: May 14, 2007
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: September 15, 2006