Form Orp-Mand - Mandatory Participation Form
Download a blank fillable Form Orp-Mand - Mandatory Participation Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Orp-Mand - Mandatory Participation Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1*EZ
ORP-MAND
Florida Retirement System
12/13
State University System Optional Retirement Program (SUSORP)
Enrollment
Mandatory Participation Form
PO Box 9000, Tallahassee, FL 32315-9000
Toll Free: 877-377-3675
Local: 850-488-8837
Fax: 850-410-2196
Per paragraph 121.051(1)(a), Florida Statutes, all faculty members in a College of Medicine at a state university that
has a faculty practice plan, are compulsory members of the State University Optional Retirement Program (SUSORP)
for the State University System.
Name
_____________________________________
____________________________
___________
:
(Last name)
(First name)
(Middle initial)
Social Security Number: ___________________ Birth Date: ____________Gender: Male ___ Female ____
mm/dd/yyyy
As a mandatory participating SUSORP member, I elect the following:
Required Employer and Employee Contributions
Voluntary Employee Contribution
The total employer contribution is 5.14%. I choose to allocate
Provider Company
contributions to one or more provider companies as indicated
(Total percentage must not
below. My 3% required employee contribution will also be
exceed 5.14% of your salary)
allocated at the same ratio.
MetLife Investors
%
%
TIAA-CREF
%
%
VALIC
%
%
Jefferson National
%
%
ING
%
%
0.00
Total
___________
Total
___________
0.00
(Must equal 5.14%)
(Must not exceed 5.14%)
I understand that:
1.
It is my responsibility to ensure that my tax-deferred income deductions do not exceed the maximum amount set in
the Internal Revenue Service Code and Regulations.
2.
I may choose to have up to 5.14% of my adjusted gross taxable salary deducted as my Voluntary Employee
Contribution; however, (a) I must be under the maximum exclusion allowance and (b) my adjusted gross income
minus any payroll deductions (e.g., credit union, or 457 plan), must be sufficient to cover the Voluntary Employee
Contribution.
Member Signature: ____________________________________
Date: ________________________
TO BE COMPLETED BY EMPLOYER:
Agency Name: ________________________________________________ Agency Number: ______________
Class Code: _____________
Position Number: ______________
Position Title: _____________________________________________________________________________
Date of Employment: __________________ Effective Date: ______________
I certify that the above information is correct and this member is employed in a Mandatory SUSORP position and has
executed a contract(s) with the SUSORP provider(s) elected above.
________________________________________
________________
Authorized Personnel Signature
Date
Rule 60U‐1.004, F.A.C.
Page 1 of 1
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Pr-371 - Statement Of Exemption From Mandatory Participation - New York State Department Of Taxation And Finance
Financial
Form Tr-371 - Promptax - Withholding Tax Statement Of Exemption From Mandatory Participation
Financial
Form Orp-3 - Optional Retirement Program Of The University Of North Carolina Acknowledgement Of Particpation
Legal
Form Orp-rmd-1 - Application For Required Minimum Distribution Authorization - State University System Optional Retirement Program (susorp)
Legal
Related Categories
Parent category: Legal