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

Cash Balance Benefit Program

Employee Notification and Election

continued

Section 3: For Employees Not Currently Members of the CalSTRS Defined Benefit Program

You may elect an alternative retirement plan other than the CalSTRS Cash Balance Benefit Program if one

is offered by your employer. The 60-day election period is your only opportunity to choose an alternative

plan other than the Cash Balance Benefit Program. Once the election period expires, and if you become a

Cash Balance Benefit Program participant, you will not be allowed to change to a different alternative plan.

However, if you choose an alternative plan other than the Cash Balance Benefit Program, you may elect the

Cash Balance Benefit Program at any time. If your employer subsequently offers Social Security, you may opt

out of the Cash Balance Benefit Program and into Social Security at that time.

If you do not return this form to your employer with an election choice, you will automatically default into the

Cash Balance Benefit Program. At any time during your participation in the Cash Balance Benefit Program or

other alternative retirement plan, you may elect the CalSTRS Defined Benefit Program.

ELECTION CHOICE

I elect Cash Balance Benefit Program coverage and understand contributions will be immediately deducted from my

first paycheck.

My employer offers and I elect Social Security coverage.

My employer offers and I elect the alternative retirement plan coverage indicated below.

NAME OF PLAN OFFERED BY EMPLOYER

If your employer offers an alternative retirement plan, your employer is required to notify you of your right to

elect such alternative plans pursuant to Education Code section 26300.

Section 4: Certification

This document must be properly completed and returned to your district office within 60 days.

I, _____________________________________________________________ have read and understand the information describ-

ing the Cash Balance Benefit Program and made the election indicated. If I have elected the Cash Balance Benefit Program,

then I hereby certify I understand that while working for this employer in an eligible position, I will remain in the Cash Balance

Benefit Program unless my employer elects to discontinue the Cash Balance Benefit Program, or I terminate all employment

covered by the Cash Balance Benefit Program. I further understand that I may elect at any time to become a member of the

CalSTRS Defined Benefit Program. I have received information on both of these CalSTRS programs.

I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. I

understand that perjury is punishable by imprisonment for up to four years (Penal Code section 126).

I understand it is a crime to fail to disclose a material fact or to make any knowingly false material statements for

the purpose of altering a benefit administered by CalSTRS and it may result in penalties, including restitution, up

to one year in jail and a fine of up to $5,000 (Education Code section 22010).

EMPLOYEE SIGNATURE

DATE (MM/DD/YYYY)

The employer’s signature on this document certifies that the employee has been provided with a CalSTRS Cash Balance

Benefit Program election package, as well as the CalSTRS Member Handbook.

SIGNATURE OF AUTHORIZED EMPLOYER REPRESENTATIVE

DATE (MM/DD/YYYY)

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

Employee Notification And Election-Instructions Page 3