To delete one obsolete form and add one new form to listing of forms in rule; and enhance the user friendliness of listing by providing more information on how a copy of each form listed in this rule may be obtained.

 

DEPARTMENT OF MANAGEMENT SERVICES
Division of Retirement

RULE NO.: RULE TITLE:
60S-9.001: Approved Forms
PURPOSE AND EFFECT: To delete one obsolete form and add one new form to listing of forms in rule; and enhance the user friendliness of listing by providing more information on how a copy of each form listed in this rule may be obtained.
SUMMARY: The amendments set forth removes one obsolete division form from list of forms in rule; adds one new division form to list of forms in rule and enhances the list to reflect how each form may be obtained.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:
The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the agency.
The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: Not required because there are no adverse impacts on economic growth, business competitiveness or regulatory costs of more than $1M in the aggregate within five years of implementation.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
RULEMAKING 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, 121.053, 121.081, 121.091, 121.111, 121.115, 121.1122, 121.121, 121.125, 121.35, 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(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: January 4, 2013, 10:00 a.m., ET
PLACE: Division of Retirement of the Department of Management Services, Director’s Conference Room, Suite 208, 1317 Winewood Blvd., Bldg 8, Tallahassee, Florida 32399-1560
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 48 hours before the workshop/meeting by contacting: Richard Clifford, Senior Benefits Analyst, Division of Retirement, Department of Management Services at [phone] or via e-mail at [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
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 incorporated by reference throughout Chapter 60S, F.A.C., providing form number, form title, form description and how to obtain a copy of each form listed. 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 by calling [phone]. 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.	TITLE/DESCRIPTION/HOW TO OBTAIN
1. BEN-001	Florida Retirement System Pension Plan Beneficiary Designation Form Active Members Only – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Enrollment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
2. FRS-400	Florida Retirement System Application for Special Risk Membership Law Enforcement/Correctional Officers – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Enrollment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
3. FRS-401	Florida Retirement System Special Risk Credit for Past Service – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Enrollment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
4. FRS-402	Florida Retirement System Application for Special Risk Equivalent Credit – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Enrollment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
5. FRS-404	Florida Retirement System Application for Special Risk Administrative Support Class – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Enrollment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
6. FRS-405	Florida Retirement System Application for Special Risk Membership Firefighters/Paramedics/EMTs – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Enrollment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
7. ERQ-1	Florida Retirement System Pension Plan Employment Relationship Questionaire for Retirees Within the 2nd – 12th Months – a five-page form which may be obtained by calling the Division’s Enrollment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
8. BLE-1	Florida Retirement System Pension Plan Ballot for Member of an Existing Retirement System – a one-page form which may be obtained by calling the Division’s Enrollment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
9. SMSD-1	Florida Retirement System Senior Management Service Class Designated Position Form – a two-page document consisting of one-page of instruction and a one-page form which may be obtained from the Employer page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Enrollment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
10. FRS-410	Florida Retirement System Application for Special Risk Class Membership Forensic Discipline from October 2005 through June 2008  – a one-page form which may be obtained by calling the Division’s Enrollment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
11. FRS-415	Florida Retirement System Application for Special Risk Class Membership for Forensic Discipline effective July 2008 – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Enrollment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(b) State Board of Administration – Enrollment and Election forms.
FORM NO.	TITLE/DESCRIPTION/HOW TO OBTAIN
1. OCC-1	Community College Optional Retirement Program (CCORP) Enrollment Form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the MyFRS Guidance Line toll free at [phone]. If hearing or speech impaired, call the MyFRS Guidance Line via T.D.D. at the Florida Relay System by dialing 711 or [phone].
2. OCC-2	Community College Optional Retirement Program (CCORP) Retirement Plan Conversion Form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the MyFRS Guidance Line toll free at [phone]. If hearing or speech impaired, call the MyFRS Guidance Line via T.D.D. at the Florida Relay System by dialing 711 or [phone].
3. SMS-1	State Senior Management Service Employees Retirement Plan Enrollment Form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the MyFRS Guidance Line toll free at [phone]. If hearing or speech impaired, call the MyFRS Guidance Line via T.D.D. at the Florida Relay System by dialing 711 or [phone].
4. SMS-3	Local Senior Management Service Employees Retirement Plan Enrollment Form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the MyFRS Guidance Line toll free at [phone]. If hearing or speech impaired, call the MyFRS Guidance Line via T.D.D. at the Florida Relay System by dialing 711 or [phone].
5. EOC-1	Elected Officers’ Class Retirement Plan Enrollment Form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the MyFRS Guidance Line toll free at [phone]. If hearing or speech impaired, call the MyFRS Guidance Line via T.D.D. at the Florida Relay System by dialing 711 or [phone].
6. ELE-1	GENERAL Retirement Plan Enrollment Form for Regular, Special Risk, and Special Risk Administrative Support Class Employees which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the MyFRS Guidance Line toll free at [phone]. If hearing or speech impaired, call the MyFRS Guidance Line via T.D.D. at the Florida Relay System by dialing 711 or [phone].
7. ELE-1-EZ	EZ Retirement Plan Enrollment Form for Regular, Special Risk, and Special Risk Administrative Support Class Employees which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the MyFRS Guidance Line toll free at [phone]. If hearing or speech impaired, call the MyFRS Guidance Line via T.D.D. at the Florida Relay System by dialing 711 or [phone].
8. ELE-2	2nd Election Retirement Plan Enrollment Form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the MyFRS Guidance Line toll free at [phone]. If hearing or speech impaired, call the MyFRS Guidance Line via T.D.D. at the Florida Relay System by dialing 711 or [phone].
9. ELE-2-EZ	2nd Election EZ Retirement Plan Enrollment Form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the MyFRS Guidance Line toll free at [phone]. If hearing or speech impaired, call the MyFRS Guidance Line via T.D.D. at the Florida Relay System by dialing 711 or [phone].
10. ORP-16	State University System Optional Retirement Program (SUSORP) Retirement Plan Enrollment Form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the MyFRS Guidance Line toll free at [phone]. If hearing or speech impaired, call the MyFRS Guidance Line via T.D.D. at the Florida Relay System by dialing 711 or [phone].
11. CERT	Florida Retirement System (FRS) – Certification Form which may be obtained from the Employer page of the Division’s website, www.frs.MyFlorida.com, or by calling the MyFRS Guidance Line toll free at [phone]. If hearing or speech impaired, call the MyFRS Guidance Line via T.D.D. at the Florida Relay System by dialing 711 or [phone]

(2) Bureau of Retirement Calculations.

FORM NO.	TITLE/DESCRIPTION/HOW TO OBTAIN
(a) FR-11	Florida Retirement System Pension Plan Application for Service Retirement – a two-page document consisting of one page of instruction and a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(b) SR-11	State and County Officers’ and Employees’ Retirement System Application for Service Retirement – a two-page document consisting of one page of instruction and a one-page form which may be obtained by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(c) TR-11	Teachers’ Retirement System Application for Service Retirement – a two-page document consisting of one page of instruction and a one-page form which may be obtained by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(d) FR-28	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 and a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(e) MF-1	Florida Retirement System Pension Plan Statement of Military Eligibility – a two-page document consisting of one-page of information and a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(f) TR-4	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 which may be obtained by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(g) MF-2	Florida Retirement System Pension Plan Statement of Military Eligibility to Purchase Military Service Under the Out-of-State Provisions – a two-page document consisting of one-page of information and one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(h) FR-23	Florida Retirement System Pension Plan Notification of Reemployment or Suspension of Retirement Benefits – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(i) FR-23a	Florida Retirement System Pension Plan Application to Reactivate Retirement Benefits – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(j) FR-30	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 which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(k) FR-30a	Florida Retirement System Pension Plan Out-of-State Employer Request – a one-page form which may be obtained by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(l) FRS-11o	Florida Retirement System Pension Plan Option Selection for FRS Members – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(m) FST-11o	Option Selection for TRS and SCOERS Members – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(n) DP-ELE	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 and a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(o) DP-11	Florida Retirement System Pension Plan Application for Service Retirement and the Deferred Retirement Option Program(DROP) – a two-page form consisting of one page of instruction and a one page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(p) DT-11	Teachers’ Retirement System Application for Service
	Retirement and the Deferred Retirement Option Program(DROP) – a two-page document consisting of two page of information and a one-page form which may be obtained by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(q) DS-11	State and County Officers’ and Employees’ Retirement System Application for Service Retirement and the Deferred Retirement Option Program (DROP) – a two-page document consisting of two page of instruction and a one-page form which may be obtained by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(r) DP-EXT	Florida Retirement System Pension Plan Extension of Deferred Retirement Option Program (DROP) for Specified K-12 Instructional Personnel – a one page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(s) PRO-1	Florida Retirement System Pension Plan (401(a) Plan) Pretax Direct Rollover/Transfer Form – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(t) HIS-IP	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 which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(u) HIS IP-2	Florida Retirement System Health Insurance Subsidy Certification for Investment Plan Members – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(v) SA-1	Division of Retirement Spousal Acknowledgement – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Bureau of Retirement Calculations toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].

(3) Bureau of Benefit Payments.

FORM NO.	TITLE/DESCRIPTION/HOW TO OBTAIN
(a) FR-13	Florida Retirement System Pension Plan Application for Disability Retirement – a four-page document consisting of two pages of instruction and a two-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(b) FR-13a	Florida Retirement System Statement of Disability by Employer – a two-page form which may be obtained from the Employer page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(c) FR-13b	Florida Retirement System Physician’s Report of Disability a two-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(d) TR-13	Teachers’ Retirement System of Florida Application for Disability Retirement – a one-page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(e) TR-13a	Teachers’ Retirement System of Florida Member’s Statement of Disability – a one-page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(f) TR-13b	Teachers’ Retirement System of Florida Physician’s Report of Disability – a one-page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(g) SR-13	State and County Officers’ and Employees’ Retirement System  Application for Disability Retirement – a one-page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(h) SR-13a	State and County Officers’ and Employees’ Retirement System Member’s Statement of Disability – a one-page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(i) SR-13b	State and County Officers’ and Employees’ Retirement System Physician’s Report of Disability – a one-page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(j) FR-13e	Florida Retirement System Retiree’s Report of Continuing Disability – a two-page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(k) FR-13f	Florida Retirement System Physician’s Report of Reexamination – a two-page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(l) TR-13e	Teachers’ Retirement System Retiree’s Report of Continuing Disability – a four page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(m) TR-13f	Teachers’ Retirement System Physician’s Report of Reexamination – a four-page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(n) SR-13e	State and County Officers’ and Employees’ Retirement System Retiree’s Report of Continuing Disability – a four-page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(o) SR-13f	State and County Officers’ and Employees’ Retirement System Physician’s Report of Reexamination – a four-page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(p) FRS-M81	Florida Retirement System Pension Plan Request for Refund – a one page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s DROP Termination and Refund Payment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(q) HIS-1	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 which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Retired Payroll Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(r) FST-12	Florida Retirement System Pension Plan Beneficiary Designation Form (Retired Members Only) – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(s) JA-1	Florida Retirement System Pension Plan Change of Joint Annuitant Form (Retired Members Only) – a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(t) AAPS	Florida Retirement System Pension Plan Affidavit Attesting to Payee Status – a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone]
(u) FST-11b	Florida Retirement System Pension Plan Application of Beneficiary for Monthly Retirement Benefits – a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(v) FST-11g	Florida Retirement System Pension Plan Application of Beneficiary for Benefit Payment – a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(w) TR-11c	Teachers’ Retirement System Application for Survivor Benefits – a two-page document consisting of one- page of information and a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(x) SRF-2	Florida Retirement System Pension Plan Student Report Form – a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(y) SRF-3	Florida Retirement System Pension Plan Authorization for Release of Information – a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(z) SVF-2	Florida Retirement System Pension Plan Affidavit Attesting to Eligibility – a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(aa) DIS-1	Florida Retirement System Pension Plan Disclaimer of Benefits – a two-page document consisting of one-page of instruction and a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(bb) JA-NUL	Florida Retirement System Pension Plan Joint Annuitant Nullification Form – a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(cc) FR-30b	Florida Retirement System Pension Plan Verification for In-State or Out-of-State Service Credit – a two-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(dd) DP-TERM	Florida Retirement System Pension Plan Deferred Retirement Option Program (DROP) Termination Notification – a one-page form which may be obtained by calling the Division’s DROP Termination and Refund Payment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(ee) DP-PAYT	Florida Retirement System Pension Plan Deferred Retirement Option Program (DROP) Selected Payout Method – a one-page form which may be obtained by calling the Division’s DROP Termination and Refund Payment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(ff) DP-JOINT	Florida Retirement System Pension Plan Deferred Retirement Option Program (DROP) Joint Annuitant Verification – a one-page form which may be obtained by calling the Division’s DROP Termination and Refund Payment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(gg) DP-12	Florida Retirement System Pension Plan Beneficiary Designation Form for the Alternate Payee of a DROP Participant – a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(hh) SB-13b	Florida Retirement System Pension Plan Physician’s Report – a two-page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(ii) FST-11so2	Florida Retirement System Pension Plan Application for Survivor Benefits – a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(jj) DP-TEOC	Florida Retirement System Pension Plan Deferred Retirement Option Program (DROP) Elected Officers’ Termination Notification – a one-page form.
(jj) (kk) DIS-2	Florida Retirement System Pension Plan Disclaimer of Benefits– a two-page document consisting of one page of instruction and a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(kk) (ll) DIS-3	Florida Retirement System Pension Plan Disclaimer of Benefits – a two-page document consisting of one page of instruction and a one-page form which may be obtained by calling the Division’s Survivor Benefits Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(ll) (mm) DP-VOID	Florida Retirement System Pension Plan Deferred Retirement Option Program (DROP) Void Form – a one-page form which may be obtained by calling the Division’s DROP Termination and Refund Payment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(mm) (nn) SRA-1 Rev.	Florida Retirement System Pension Plan Service Retirement Agreement – a one-page form which may be obtained by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(nn) (oo) PR-13	Florida Retirement System Investment Plan Application for Disability Retirement – a four-page form consisting of two pages of instruction and a two-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(oo) (pp) PR-11o	Florida Retirement System Investment Plan Option Selection for FRS Members – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(pp) (qq) DP-TEOC-2	Florida Retirement System Pension Plan Deferred Retirement Option Program (DROP) Elected Officer DROP Termination Notification – a one-page form which may be obtained by calling the Division’s DROP Termination and Refund Payment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(qq) (rr) DP-TEOC-3	Florida Retirement System Pension Plan Deferred Retirement Option Program (DROP) Elected Officer Employment Termination Notification – a one-page form which may be obtained by calling the Division’s DROP Termination and Refund Payment Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(rr) (ss) SA-2	Florida Retirement System Investment Plan Spousal Acknowledgment Form for Disability Retirement – a one-page form which may be obtained from the Forms page of the Division’s website, www.frs.MyFlorida.com, or by calling the Division’s Disability Determination Section toll free at [phone], or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].
(ss) REF-PAYT	Florida Retirement System (FRS) Pension Plan Refund Payout Selection - a one page form which may be obtained by calling the Division’s DROP Termination and Refund Payment Section Toll Free at [phone], if calling from outside the Tallahassee calling area, or locally at [phone], or if hearing or speech impaired by calling the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].

(4) Administration.

FORM NO.	TITLE/ DESCRIPTION/HOW TO OBTAIN
SAPS	Florida Retirement System Statement Attesting to Payee Status – a one-page form which may be obtained by calling the Division’s Research and Education Section toll free at (877) 377-173, or [phone] in the Tallahassee calling area. If hearing or speech impaired, call the Division via T.D.D. at the Florida Relay System by dialing 711 or [phone].

Rulemaking 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, 121.053, 121.081, 121.091, 121.111, 121.115, 121.1122, 121.121, 121.125, 121.35, 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, 9-18-07, 5-22-08, 4-2-12,                            .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Sarabeth Snuggs, State Retirement Director
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Craig J. Nichols, Secretary
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: November 08, 2012
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: October 19, 2012, Vol. 35/54