Form Fr-9 - Retirement System Information Request
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1FR-9
Florida Retirement System
*q1*
Rev. 06/04
Information Request
Calculations
PO Box 9000
Tallahassee FL 32315-9000
850 907-6500 Toll Free 844 377-1888
Member
Name
Birth Date
SSN
Mailing
Address
Home Phone
City
State
Zip
Work Phone
Spouse/Joint Annuitant
Birth
Name
Date
Relationship
(This is not an official beneficiary designation for retirement.)
Members of the Florida Retirement System (FRS) can name only a spouse or joint annuitant to receive survivor benefits under option 3 or
4. See the FRS Today booklet for definition of joint annuitant.
Information Requested
Compute an estimate of benefits based on a termination of employment on __________________
Current annual rate of pay $_______________
Check length of contract or regular work year:
9
10
11
12
months
Compute Deferred Retirement Option Program (DROP). Begin date ______________ End date ______________
For members employed by educational agencies only: Your employer must certify that your position meets the definition of
instructional personnel under Section 1012.01(2), Florida Statutes, upon entering DROP. Are you currently in such a position?
Yes______ No______
Compute the amount due for:
____ Leave of absence – Contact your personnel office for form FR-28. Complete the FR-28 and attach to this form.
____ In-state or out-of-state service – Contact your personnel office for form FR-30. Requirements for purchasing your in-state
or out-of-state service (includes federal and non-wartime military service) are listed on the FR-30. Upon receipt of the FR-
30 from your former pension system, we will audit your retirement account and advise you of the cost to claim your in-
state or out-of-state service.
____ Military service – Attach a copy of your discharge papers (DD-214 or equivalent) for each period of military service you
wish to claim. Requirements for purchasing military service can be found on the form MF-1 or in the FRS Today booklet
(available in your personnel office). If you are not eligible to claim your military as active wartime service or as a leave of
absence, you may be eligible to claim the service as out-of-state service.
____ Refunded service – You must be reemployed in a position covered for retirement for one continuous year.
Compute my total years of service.
Other
Current
Member
Job Title
Signature
Date
Employer Use Only
Is the member currently on leave of absence?
Contact person
List all periods of Workers’ Compensation
Agency No.
Phone
Retirement credit for Workers’ Compensation is available at
Comments:
no cost to the member. However, restrictions do apply. For a
listing of requirements for Workers’ Compensation, contact
your personnel office and request a copy of Chapter 2,
Section I.C. in the FRS Employer Handbook.
Rule 60S-9.001, F.A.C.
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