Form 29211 - Request For Estimate Of Benefits printable pdf download

Form 29211 - Request For Estimate Of Benefits

Request for Estimate

of Benefits

Instructions for Completing this Form

Please Read Carefully

IMPORTANT:

Remove the form. Do not return these instructions to PERF.

Please type or print. Use black ink.

Complete all information.

Return the completed form directly to PERF.

PRIVACY NOTICE

All Social Security Numbers are requested by this agency in accordance with the requirements of Internal Revenue

Code. Disclosure is mandatory; and this form will not be processed without this information.

Important Information

We can provide only one Estimate of Benefits within any 12 month period. Because estimates are

prepared based on current information, actual benefits received at the time of retirement may

differ.

Regular/Early Retirement Benefits

We can only provide an estimate of benefits once you are within one year of being eligible for

retirement:

Age 50 with 15 years of service (for reduced benefits)

Age 60 with 15 years of service

Age 65 with 10 years of service

You are at least 55, and your age and years of service add up to 85

(Rule of 85)

Disability Benefits

In order to receive PERF Disability Benefits, you must:

Have at least five years of creditable service with PERF before the termination of salary,

employer provided income protection benefits, Worker’s Compensation benefits, or leave

under the Family and Medical Leave Act (FMLA).

Be determined by the Social Security Administration to be disabled.

Be receiving salary, employer provided income protection benefits, Worker’s

Compensation benefits, or leave under the Family and Medical Leave Act (FMLA) as of the

onset date established by Social Security.

You must provide PERF with a copy of your Social Security award letter.

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Form 29211 - Request For Estimate Of Benefits