Employee Notification And Election-Instructions (Page 2 of 3) in pdf

Employee Notification And Election-Instructions Page 2

Cash Balance Benefit Program

Employee Notification

California State Teachers’ Retirement System

and Election

P.O. Box 15275, MS 17

Sacramento, CA 95851-0275

800-228-5453

CB 533 rev 8/12

Please read instructions on the previous page before completing this form.

This document must be completed and returned to your employer within the 60-day election period defined by

your employer. Your employer must keep a copy of this document on file and mail the original to CalSTRS.

Section 1: Employee Information

NAME (LAST, FIRST, INITIAL)

CLIENT ID OR SOCIAL SECURITY NUMBER

MAILING ADDRESS

(

)

CITY

STATE

ZIP CODE

HOME TELEPHONE

EMAIL ADDRESS

SCHOOL DISTRICT NAME

Section 2: For Employees Currently Members of the CalSTRS Defined Benefit Program

As a current CalSTRS Defined Benefit Program member, you are eligible to participate in the Cash Balance

Benefit Program if you are employed to perform creditable service by one of the following:

• School district or county office of education on an hourly or daily basis, or contracted for less than

50 percent for each full-time position.

• Community college district on a part-time or temporary basis (semester to semester), or for not more than

67 percent of the hours per week considered a regular full-time assignment.

• Governing body of an employer as a trustee member.

You will retain your Defined Benefit Program membership with your employer unless you elect the CalSTRS

Cash Balance Benefit Program using this document, within the election period identified by your employer.

ELECTION CHOICE

I am currently a member of the CalSTRS Defined Benefit Program and hereby elect to participate in the

CalSTRS Cash Balance Benefit Program for service performed with this employer only.

I am currently a member of the CalSTRS Defined Benefit Program and hereby waive my right to participate in the

CalSTRS Cash Balance Benefit program with this employer only.

PAGE 1 OF 2 • CASH BALANCE EMPLOYEE NOTIFICATION AND ELECTION • REV 8/12

Employee Notification And Election-Instructions Page 2