The purpose of this rule development is to propose the adoption of 1 new Division form, 25 revised Division forms, delete a redundant form listing, 17 corrections to form titles as listed in Rule, 3 corrections to form descriptions as listed in rule ...

DEPARTMENT OF MANAGEMENT SERVICES
Division of Retirement

RULE NO: RULE TITLE
60S-9: APPROVED FORMS
60S-9.001: Approved Forms
PURPOSE AND EFFECT: The purpose of this rule development is to propose the adoption of 1 new Division form, 25 revised Division forms, delete a redundant form listing, 17 corrections to form titles as listed in Rule, 3 corrections to form descriptions as listed in rule and to update the revision dates of the 5 State Board of Administration (SBA) forms incorporated by reference.
SUBJECT AREA TO BE ADDRESSED: Forms.
SPECIFIC AUTHORITY: 121.031 FS.
LAW IMPLEMENTED: 121.051(1)(a), 121.35 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: October 2, 2006, 9:00 a.m.
PLACE: Department of Management Services, Conference Room Suite 101, 4050 Esplanade Way, Tallahassee, Florida
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, 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]
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 Julie Shaw at [phone]. If you are hearing or speech impaired, please contact the agency by calling [phone].

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT 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 (850)488-5706488-5540.  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. 07-06) (07/04)	Community College Optional Retirement Program (CCORP) Retirement Plan Choice Form for Eligible Employees.
2. OCC-2 (Rev. 07-06) (11/04)	Retirement Plan Conversion Form for Community College Optional Retirement Program (CCORP) Members.
3. SMS-1 (Rev. 07-06) (Rev. 07/04)	State Senior Management Service Employees Retirement Plan Enrollment Form.
4. SMS-3 (Rev. 07-06) (Rev. 07/04)	Local Senior Management Service Employees Retirement Plan Enrollment Form.
5. EOC-1 (Rev. 07-06) (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,________.