Reemployment Retiree Notification Form - Strs Ohio printable pdf download

REEMPLOYED RETIREE NOTIFICATION

For use by all employers except colleges and universities.

Section 1 — Employee Information

Instructions

Name _______________________________________________________

You must notify STRS Ohio of

the employment of a retiree of an

Social Security no. ____________________________________________

Ohio public retirement system or an

Birth date ____________________________________________________

alternative retirement plan (ARP)*

Gender:

within 10 business days of his or her

first date on payroll.

❑ Male

❑ Female

This information must be submitted

Address _____________________________________________________

via the employer website

City ________________________________________________________

( ) using

Employer Self Service (ESS) or the

State _____________________________ ZIP code __________________

secure file upload application. This

First date of service after retirement _______________________________

form is provided for your internal

use. Please do not submit paper

Type of retirement benefit:

copies to STRS Ohio.

❑ Age and service retirement

❑ Disability

❑ ARP Allowance

Note: If the employee recently retired

Effective retirement date ________________________________________

from your school, you do not need to

Retirement system paying the benefit:

submit the SSA-1945 form. Otherwise,

you must submit a completed

❑ State Teachers Retirement System of Ohio

SSA-1945 form signed by the

❑ Ohio Public Employees Retirement System

employee to STRS Ohio by mail

❑ School Employees Retirement System of Ohio

or fax it to (614) 227-7893.

❑ City of Cincinnati Retirement System

* ARP as defined under Section 3305.02, Revised

❑ Highway Patrol Retirement System

Code (R.C.).

❑ Ohio Police & Fire Pension Fund

❑ Alternative Retirement Plan (ARP)

Section 2 — Employer Information

School _______________________________________________ Employer number _______________________

Name ________________________________________________ Title __________________________________

❑ Please check this box if this retiree was reemployed under Section 3307.353, R.C., that requires public notices be

given and public meetings be held for certain rehires.

I certify that the requirements for reemployment under Section 3307.353, R.C., were met.

Signature _____________________________________________ Date __________________________________

7/13/1

50-295

Reemployment Retiree Notification Form - Strs Ohio

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