Employers' Pensions and Benefits Administration Manual (EPBAM)
   

 

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Public Employees' Retirement System  
Enrollment Application Instructions


An employer must log on to the Employer Pensions and Benefits Information Connection, or EPIC, and complete the online PERS Enrollment Application in order to enroll a newly hired employee in the Public Employees' Retirement System, or PERS. However, there are exceptions:

  • If the newly hired employee is to be enrolled in the PERS Law Enforcement Officers (LEOs) group, the printed version of the PERS/TPAF Enrollment Application must be used.

Employers are reminded to submit the online EPIC PERS/TPAF Enrollment Application for each newly hired employee promptly, so that the Division of Pensions and Benefits can process the enrollment in a timely manner. Delayed and forced enrollments can be costly to the employer.

Employers requiring help in completing the online PERS Enrollment Application through EPIC should refer to the EPIC User's Information Guide.

Employers wishing to sign up for EPIC at this time can refer to the EPIC Registration Information page.

At the time of enrollment, the employee's estate will automatically be designated as beneficiary for any death benefits payable. Employers should strongly encourage new employees to register to use MBOS in order to update their beneficiary information after enrollment.

Please see the "Beneficiary Designation" section of the PERS Enrollments page for more information, including how a member can change his or her beneficiary information once enrolled.

Click here to view the fill in and print PERS/TPAF Enrollment Application.
(Adobe Acrobat 4.0 or higher required to use this form.
If you do not have Adobe Acrobat 4.0 or higher, click here.)

The PERS/TPAF Enrollment Application will open in a separate window, enabling you to follow the item-by-item Enrollment Application form instructions below to guide you while you complete the application.*

The PERS/TPAF Enrollment Application above is in a fill-in and print format:

  • Use your keyboard to type in the information requested for each item.
  • Use your tab button to advance to the next item.
  • Then, print the completed form from your printer.
  • Sign the "Employer Certification" portion of the form.
  • Mail the form to: New Jersey Division of Pensions and Benefits, PO Box 295, Trenton, NJ 08625-0295.

In addition, the employer should strongly encourage new employees to designate a beneficiary(ies) for pension and group life insurance benefits by signing up for the Member Benefits Online System (MBOS), which will enable them to designate beneficiaries online by using the MBOS "Designation of Beneficiary" application.

If the member does not complete the d esignation of beneficiary, the enrollment will be processed with the member's estate listed as both group life insurance and pension beneficiary. In such cases, an insurance packet and policy rider confirming the estate as beneficiary will be mailed to the member.

In order to change the beneficiary information in effect, the member must use the online MBOS Designation of Beneficiary application.

It is important for employers to submit the Enrollment Application in a timely manner, so that enrollment can occur.

The employer should not delay in submitting the Enrollment Application, because late and forced enrollments can be costly to the employer.

*Brief instructions for each item on the form can also be found on the form itself. When you click on any item heading, a link will take take you to specific instructions for completing that item. Return to the application by clicking on the "Back to Previous View" button, or the link provided on the form for this purpose. However, the instructions below clarify and provide important employer-specific details for correct completion of the Enrollment Application.

Back to PERS Enrollment Guide


PERS/ TPAF Enrollment Application Instructions

Location Number and Membership Number

The location number and the membership number spaces in the box at the top of the application are to be completed by the Division of Pensions and Benefits.

Pension Fund

Check the box indicating that the employee is a member of the Public Employees' Retirement System, or PERS.

Part I: Applicant Information

Item 1: Name

Enter the employee's full legal name (last, first, and middle initial). Nicknames should not be used. If applicable, please indicate the member's maiden name or name used during a previous membership in the space provided.

Item 2: Address

Enter the employee's current mailing address.

Item 3: Social Security Number

Enter the employee's Social Security number (numbers only).

Item 4: Gender

Please check the appropriate box indicating the employee's gender.

Item 5: Date of Birth

Enter the employee's month, day, and year of birth, using the format mm/dd/yyyy. Since the employee's proof of age is required at the time of retirement, a copy of the employee's birth certificate, baptismal certificate, or any other acceptable form of proof of age should be submitted at the same time this application is filed. (Please do not send the original.)

Do not delay filing the Enrollment Application if the proof of age is not available.

Item 6: Daytime Phone Number

Provide the applicant's daytime phone number, with area code (and extension, if applicable).

Item 7: Is member receiving retirement benefits from a New Jersey State-administered or local New Jersey retirement system?

Check "Yes" or "No". When checking "Yes", enter also the name of the New Jersey State-administered retirement system or a local New Jersey retirement system from which applicant is receiving retirement benefit.

There are many rules and laws governing the return to public employment and reenrollment following retirement from a NJ State-administered retirement system. For further information, please see the "Employment after Retirement" section provided in the Manual.

Employer Information

Item 8: Name of the Employer

Please list the complete name of the employing location.

For Boards of Education
Most school teachers and staff are employees of the presiding board of education, not the school in which they work. The board of education would then be the "employing agency" and must be listed as the employer on record, on the Enrollment Application, rather than the name of the school.

Item 9: County

Please list the county in which the employer is located.

Item 10: Location Number, Bureau Number, and Payroll Number

Location Number: This is the number assigned to your employing location by the Division of Pensions and Benefits. The number you include on this line is specific to the retirement system into which the employee will be enrolled. It is very important that the Location Number be included.

Bureau Number: Please include the Bureau Number if one has been assigned to your location.

Payroll Number: The Payroll Number is required for State agencies paid through Centralized Payroll only.

The Location Number, Bureau Number (if applicable), and Payroll Number (State locations paid through Centalized Payroll only) should be entered as appearing on your location's quarterly Report of Contributions (ROC).

Item 11: Title/Position of Applicant

Please indicate the title/position under which the employee was hired.

On-call Employees

If the employee is "on-call", the title entered should reflect the employee's on-call status. For example: "On-call Substitute Teacher", "On-call Substitute Bus Driver," etc.

Item 12: Is applicant employed by more than one public employer?

Check "Yes" or "No". If "Yes" is checked, please enter the full name of each employing location.

Item 13: Item 13 information is to be completed for TPAF applicants only. PERS applicants should skip to Item 15.

Items 13 a-c: Date Employment Began, Permanent Appointment Date, and Whether Position is Temporary or Provisional

Item 14a (For PERS Applicants): Date Employment Began

Enter the date on which applicant began employment.(See the notes below)

Item 14b: Regular or Permanent Appointment Date

Enter the date of the applicant's regular or permanent appointment.

This should be the date the employee was given permanent status in their title, or the first day of the 13th consecutive month of employment. The answer will depend on whether your employing location is a Civil Service location, a non-Civil Service location, or if the employee is an on-call 10-month employee. (See the notes immediately below.)

If employees are permanent in their positions, they must be enrolled as of their regular or permanent appointment date. They may apply for a cost quotation to purchase all temporary service, if any, rendered immediately preceding appointment.

Enrollment of Optional Enrollees

If an employee's enrollment is optional and the decision is made to enroll in the retirement system, the enrollment will be effective on the first of the month following receipt of the application at the Division of Pensions and Benefits.

Item 14 c: Temporary or Provisional

Indicate whether the applicant is still considered a temporary or prrovisional employee.

Temporary (provisional) Employees Having 12 Consecutive Months of Service

If the employee is temporary or provisional in his or her position and has been employed in that position for 12 consecutive months, he or she must be enrolled in the retirement system. He or she may apply for a cost quotation to purchase all prior temporary service.

Notes for Civil Service Employers Regarding Items 14a-c.

  1. If the individual is still considered a temporary (provisional) employee, only Item 14a, "Date Employment Began", should be completed, not 14b:

    The date employment began represents the date the employee began continuous service covered by the PERS provisions. (Continuous service is a key eligibility criterion for membership in the PERS.) This may be a date later than when the employee was first hired; if, for example, the employee had been intermittently or seasonally employed, or on-call too infrequently to become eligible for PERS membership.

  2. If an employee is hired from a certified Civil Service list, or is hired in an unclassified title, the dates in Items 14a and 14b would be the same.

  3. If a person is hired provisionally and later certified through Civil Service to a position within one year from the date employment began, the date in Item 14a would be the date employment began, and 14b would be the date of regular appointment (RA) status.

For Non-Civil Service Employers Concerning Items 14 a-c

If the employee is working in a regularly budgeted position (you can count on the position being funded from year to year), then the answers to Items 14a and 14b would be identical.

If for some reason the date of hire and the date of permanent status are different, be sure to attach a letter of explanation to the Enrollment Application. This would avoid the need for Enrollment Section to send a letter asking for clarification and thus avoid a delay in enrollment.

For example, an employee began work on June 1 in a position that was only temporarily funded. On November 1 the job became a regularly budgeted position. The date of permanent appointment would be November 1 (Item 14b), and the date of employment would be June 1 (Item 14a).

Date of Enrollment of On-call Ten-month Employees

The minimum number of days a ten-month, on-call employee can work to qualify for membership in PERS is 100. If the employee works 100 days or more during the regular work year, then he or she becomes eligible when returning to work to begin the second year, not when the 100 day mark is reached.

For example, an on-call, ten-month employee was hired on September 10, 2000 and worked, on average, 20 days per month (100 days total) as of the end of January 2001. Even though this employee has reached 100 days of on-call employment with one employer by January, the employee is not yet eligible for enrollment.

If the employee returns to work in September 2001, the employee would be enrolled.

In this example, Item 14a would show a date of September 10, 2000; Item 14b would show September 1, 2001. The Enrollment Section at the Division would enroll the on-call employee as of September 1, 2001.

The applicant would then be permitted to buy the one year of temporary service that occurred before enrollment.

Item 15: Elected Official

Indicate whether the applicant is an elected official. On or after July 1, 2007, a newly elected official is ineligible for enrollment in the PERS. (See Fact Sheet 80.)

Item 16: Appointed Official

Indicate whether the applicant is an appointed official. On or after July 1, 2007, a newly appointed official who does not have an existing PERS account is ineligible for enrollment in the PERS. (See Fact Sheet 80.)

Item 17: Professional Services Contract

Indicate whether the individual is working under a professional services contract or providing professional services without benefit of a contract.

Item 18: Current Base Annual Salary

Be sure to use the current annual base salary only. Do not insert hourly or per diem rates. For hourly employees, use the best estimate of current annual base salary.

Base salary is the contractual salary of the employee. Base salary should not include bonuses, overtime pay, stipends or longevity pay, or sick or vacation time paid as a lump sum.

The Division of Pensions and Benefits cannot enter hourly or per diem rates. Base salary must be entered as an annual figure.

Item 19: Ten-month or Twelve-month Position

Indicate if the employee is employed on a ten- or twelve-month per year basis.

Item 20: Hours Worked

Indicate if the employee's hours are fixed at 35 or more hours per week for State employees, or 32 or more hours per week for local employees. This requirement applies to PERS members enrolled after May 21, 2010.

Part III: Employer Certification

Item 21: Name of Employer Representative Completing Application

Please list the name of the employer representative completing the application.

Item 22: Phone Number and Extension of Employer Representative

Please enter the phone number (with area code) and extension of the employer representative entered in Item 21 who is completing the application.

Item 23: Certifying Officer's Signature and Date

Please enter the Certifying Officer's name and today's date, using the format mm/dd/yyyy. After printing the completed form, the Certifying Officer must also sign the Enrollment Application in the space provided.

Before the Certifying Officer signs the Enrollment Application, it is suggested that the application be reviewed for missing, erroneous or inconsistent information. A little effort at this juncture can prevent lengthy delays and more work later.

The signature by the Certifying Officer must be an original signature, not a stamped copy.

Item 24: Signature and Date of Supervisor of Certifying Officer

The Certifying Officer's supervisor must also sign the Enrollment Application in the space provided, along with today's date, using the format mm/dd/yyyy.

Before the Certifying Officer signs the Enrollment Application, it is suggested that the application be reviewed for missing, erroneous or inconsistent information. A little effort at this juncture can prevent lengthy delays and more work later.

The signature by the Certifying Officer must be an original signature, not a stamped copy.

Designation of Beneficiary

There is no longer a section for beneficiary designation on the PERS/TPAF Enrollment Application. The member must first register with the Member Benefits Online System (MBOS) to nominate a beneficiary, or beneficiaries, for his or her group life insurance and/or pension benefit.

Employers should strongly recommend that new employees complete the online "Designation of Beneficiary" application through MBOS in a timely manner.

Fact Sheet #68, Designating a Beneficiary, is available to provide information to members requiring help in making their beneficiary selections for pension and/or group life insurance. Some information about selecting beneficiaries is also provided below.

If the member does not complete the Designation of Beneficiary online, the member's estate will be listed as both the group life insurance and pension beneficiary. In such cases, an insurance packet and policy rider confirming the estate as beneficiary will be mailed to the member.

To subsequently change the beneficiary information in effect once enrollment has occurred, the member must either update his or her beneficiary information online using the MBOS Designation of Beneficiary application.

Benefits for Which Beneficiary Is Named

Group Life Insurance: All employees enrolled in the PERS will be be entitled to group life insurance coverage. Members who are age 60 or older at the time enrollment must prove insurability through a medical examination administered by the Prudential Insurance Company. Additional information regarding group life insurance for employees enrolled in the PERS is available through this link.

Return of Member Contributions: The pension benefit is the return of the member's contributions to the PERS, paid in a lump sum to the member's designated beneficiary(ies) upon the member's death.

Group Life Insurance and Pension Benefit — Choosing Beneficiaries

Primary Beneficiaries

A primary beneficiary is the person (or persons) who will receive benefits at the time of an employee's death.

The member should provide each primary beneficiary's full name, current address, relationship to member, and birth date.

Contingent Beneficiaries

A contingent beneficiary is the person (or persons) who will receive the benefits at the time of the employee's death only if all of the primary beneficiaries have predeceased the employee.

The member should provide each contingent beneficiary's full name, current address, relationship to member, and birth date.

Rules for Designation of Beneficiaries

  • A member may nominate any person, persons, institution, charity, corporation, trust, your estate, etc., as primary or contingent beneficiary.

  • If more than one person is named as primary beneficiary, the following shall apply: "Share and Share Alike, Survivor or Survivors."  If multiple beneficiaries are named, it is to be understood that the beneficiaries living at the member's death will share equally in the distribution of the death benefits.  The same applies to multiple contingent beneficiaries.

  • Nicknames are not acceptable--use the beneficiary's full name. When naming a married female as beneficiary, be certain the proper name is given, e.g., Mary J. Jones, not Mrs. John R. Jones. 

  • The member may change the beneficiary designation for the group life insurance, accumulated pension deductions or last check benefit (retired members) at any time.

  • If no beneficiary designation is in effect at the time of death, or the designation section is incomplete or blank, payment will be made to the member's estate.
  • If the member has special provisions when nominating a beneficiary (i.e., names a trust), a paper version of the Active Member Designation of Beneficiary form must be completed. To obtain a copy of the form, contact the Division for more information.

When a Beneficiary is a Minor

If a member wishes to name a minor as a beneficiary for pension death and/or group life insurance benefits, the manner of the designation can make a huge difference in how benefits are paid.

  1. If a member dies leaving pension death and/or group life insurance benefits to a minor, the Division of Pensions and Benefits will withhold payment of the benefit until one of the following occurs:
    • A court ordered guardian of the minor's property is appointed by the courts and proof is forwarded to the Division, in which case the benefits will be paid to the guardian on the minor's behalf, or;
    • The minor attains age 18.
  2. The member may choose to leave pension death benefits and/or group life insurance benefits to a trust established on behalf of a minor beneficiary. There are two types of trusts, "formal" and "informal".
    • A "formal trust" is established by formal, legal documents filed with a NJ county court that establishes a person or persons or corporation as "Trustee". When designating a formal trust on behalf of a minor beneficiary, the member must clearly state "Formal Trust" on behalf of the minor, include the date of trust incorporation, and supply the name and address of a trustee to contact upon the member's death. All specified death benefits would then be paid to the trust.
    • An "informal trust" is one that has not been filed with the courts and need not be a formal agreement. In this case, the member designates a person or persons to act as "informal trustee(s)" on behalf of the minor. The informal trustee(s) would be paid the specified benefits on behalf of the minor beneficiary.

Do's and Don'ts of Beneficiary Designation

Based on frequent experience at the Division, the following "Do's and Don'ts" are suggested as a means to reduce the number of errors on beneficiary designation forms and ensure that members are well-served in this important area.

Do choose both primary and contingent beneficiaries with care.

Don't leave the address for any beneficiary blank. This will require the Division of Pensions and Benefits to generate a letter requesting the required information.

Don't neglect the birth date of each beneficiary. This will require the Division of Pensions and Benefits to generate a letter to request the required information.

Don't forget to list the relationship of each beneficiary to the member. This will require the Division of Pensions and Benefits to generate a letter to request the required information.

Updating Beneficiary Designation Information

It is very important for members to review beneficiary information periodically, especially when major life events occur, and update this information when necessary. Members wishing to change their named beneficiary(ies) must use the MBOS Designation of Beneficiary application to update this information.

 

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Last Updated: March 21, 2013