Employers' Pensions and Benefits Administration Manual (EPBAM)
   

 

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State Police Retirement System
Instructions for Forms and Applications
Pertinent to Retirement



 
 


The SPRS Application for Retirement Allowance

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Instructions for the SPRS Retirement Application

The SPRS Application for Retirement Allowance is completed in its entirety by the member. The member's signature must appear on the form. The signature and witnessing signature by the Superintendent (or authorized representative) will be verified when the application is keyed into the Division's system.

The membership number is requested at the top of the application.

Items 1-6. Member Information

On the first page of the application give the member's mame, address, Social Security number, date of birth (proof of age will be required from the member if it has not already been submitted), and the member's phone numbers at home and work.


Item 7. The member needs to inform the Division if an outstanding loan (if any) will be "carried" into retirement or will be paid in full prior to retirement.

  • All retirees can 'carry' their loans into retirement at the same monthly repayment level as when they were active members.
  • Biweekly loan payment schedules are converted to monthly payments by multiplying the biweekly payment by 2.175. 
  • The member may choose to pay off the loan in a lump sum. 
  • Interest will continue to accrue at 4.00% if the member chooses to 'carry' the loan into retirement.

Item 8. Effective Retirement Date of Member. 

Provide the member's effective date of the retirement (always the first of a month). The application must be received in the Division prior to the member's effective retirement date.

Item 9. Type of Retirement Requested

Service: Age 55, any number of years of service credit.

Special: 25 years of Service Credit, regardless of age.

Deferred: Ten or more years of Service Credit but under age 55.

Item 10. Member's Marital Status   

Indicate here the member's marital status.

Items 11-13. Name of Spouse, Social Security Number and Birth Date.

This information is required if either married or separated.  If not married at the time of retirement this space may be left blank or write "N/A."

Line 14 -  Name, Gender, Birth Date and Social Security Number of Eligible Dependent Children.

List all dependent children under age 18, or who are mentally or physically handicapped regardless of age.  Copies of birth certificates, adoption papers, and medical documentation proving disability are required for each child listed.

If additional space is needed, the member may attach additional sheets.  If additional sheets are needed to list dependent children, these also must be signed.


Designation of Group Life Insurance Beneficiary(ies).

Group Life Insurance

Non-disability retirees must have at least 10 years service credit to qualify for group life insurance death benefits. Disability retirees qualify upon retirement approval if they have life insurance as active members.

Primary Beneficiary(ies)

Those listed here receive the group life insurance, if any, at the time of death. If the member chooses multiple primary beneficiaries and one beneficiary predeceases the member, the remaining beneficiary(ies) will usually share that beneficiary's portion. Some special designations are allowable, but uncommon. Unless otherwise stated, if multiple beneficiaries are listed, they are considered "share and share alike." If the member had no active group life insurance coverage through the pension fund, then the member will not have group life insurance coverage as a retiree.

The following information should be provided: 

  • Beneficiary's name, 
  • Relationship to the member (spouse, daughter, son, father, mother, friend, grandchild, etc.), 
  • Birth date of the beneficiary, 
  • Social Security number of the beneficiary (this is optional information for the group life insurance benefit, but helps the claim processing at the time of member's death). 

    If no beneficiary is listed, the death benefits will be payable to the member's estate.

Contingent Beneficiaries

Contingent beneficiaries are paid only if all the primary beneficiaries predecease the member. The same information is needed for these beneficiaries as for the primary beneficiary(ies).

Additional primary or contingent beneficiaries can be listed on an attached and signed sheet.


SIGNATURE OF APPLICANT

The application must be signed or it cannot be processed. If any additional sheets for the retirement application are attached, then these additional sheets must also be witnessed by the signature of the Superintendent or the authorized representative.

SIGNATURE OF SUPERINTENDENT OF THE DIVISION OF THE NEW JERSEY STATE POLICE  

The Superintendent or designated representative must also sign the application to verify the member's intention to retire and validate the application.

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Certification of Service and Final Salary—SPRS Retirements

The certification form is completed by the member's employer. 

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Item 1. Name of Member  

Item 2. Membership Number

Item 3. Social Security Number

Item 4. Date of Termination of Service

This certifies that the member will not render any service or earn any salary after this date.

Item 5a. Is the member currently on suspension?  

If this is answered YES, the employer is to state the date suspension began and mark the box stating if the member is PAID or UNPAID while on suspension.

Item 5b. Is the applicant facing disciplinary action or indictment?  

If this is answered YES, a detailed explanation must be submitted by the employer. The Division will review the explanation to determine if it is sufficient for continued processing, if additional information is needed, or if submission to the SPRS Board of Trustees is required.

IF either 5a or 5b are answered YES, copies of the preliminary and final notices of disciplinary action, or the equivalents, or a copy of the indictment should be included.

Item 6. Unpaid Leaves of One Month or More, within the Last 12 Working Months 

This information shows gaps in service due to Leave of Absence (LOA). Some LOAs can be purchased by the member. A LOA for a work related incident may indicate a possible Worker's Compensation claim. If Worker's Compensation is determined, the employer may be required to submit pension contributions, until retirement, on the member's behalf.

Item 7. Base Salary Subject to Pension Fund Contributions Paid for the Last Full Year of Service. 

The last 12 months of salary must be indicated. Salary should be reported by the number of months at a given salary, the amount of the monthly base salary, the beginning and ending dates of that salary and the total base salary for the period. Salary is being certified in advance.  Therefore salary not yet paid is to be projected to the best of the employer's ability.

Item 8. Has the member received a significant annual salary increase in the last 3 years of employment?

If the answer is yes, the employer must furnish cause for the increase, with documentation. The Division may approve the increase, if justifiable, deny the increased salary, or forward the case to the Board of Trustees for determination.

Item 9. Has there been any retroactive salary paid to the employee within the past three years?

A retroactive salary increase can falsely inflate a member's salary if it is not properly credited back to the correct dates. Retroactive salaries can also incorrectly show a single salary increase, when in fact it may cover several years of increases. The beginning and ending dates for each retroactive increase and the corresponding new annual base salary should be indicated.

If the member receives a retroactive raise after the original Certification has been sent to the Division, a new Certification must be sent in. The new Certification should state 'Amended' or 'Revised for Retroactive Increase.'

Completed by denotes who actually completed the form.

Phone Number

The phone number of the person who completed the form. This number allows us to directly contact the employer for any follow up questions we may have on the Certification.

Signature of Superintendent or Authorized Representative

The Superintendent or Authorized Representative, who is the individual responsible for certifying that the information provided on this form is correct, must sign this form. This signature must be an original signature and can not be a stamped signature.

Date     

The date ndicates when the form was signed by the Superintendent. The signature date is helpful information when more than one Certification is received, by ensuring that the most recent Certification is used. Usually more than one Certification is received when there is a retroactive raise (marked "Revised for Retro" or "Retroactive Raise"), or a change in the Certification (marked "Amended").

NOTE CONCERNING WORKERS' COMPENSATION: If the member is receiving periodic payments from Workers' Compensation, the employer may be required to pay the member's pension contributions until the member's effective date of retirement. Not all Workers' Compensation payments are pensionable. No loan payments, back deductions, or arrears payments are required from the member or the employer while the member is on Workers' Compensation. Whenever possible, an official statement of the Workers' Compensation award, showing the amount of the periodic benefits and the beginning and ending dates of the benefits awarded, should be attached or mailed in under separate cover.

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The SPRS Application for Disability Retirement

 

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Instructions for Completing the
SPRS Application for Disability Retirement

The SPRS Application For Disability Retirement is completed in its entirety by the member. The member's signature must be notarized. The signature and notarization will be verified when the application is keyed into the Division's system.

Part One

Lines 1-6:

Request basic member information:  Membership Number, SSN (Social Security Number), member's Name, Date of Birth (Proof-of-Age will be required from the member if it has not already been submitted), member's Home Mailing Address, Home Phone and Work Phone numbers.

Line 7:

Asks to supply the Division with the official Work Title under which the member is currently employed.

Line 8 - Type of Disability Retirement: 

The type of Disability Retirement requested: Accidental Disability or Ordinary Disability. .

Line 9: "I declare that I am incapacitated for further service in the work title listed in Item 7 due to the following reasons:

This question should be answered by the member explaining in what way a disabling condition prevents continued service in the job title listed in question 7.  This should be completed in the member's own words, and should reflect the pertinent job duties that fall under the specific job title.

Line10 -  Retirement Effective Date: 

The effective date of the retirement (always the first of a month). The application must be received in the Division prior to the member's effective retirement date.

Line 11 - If you will have an outstanding loan balance at retirement, how do you want to pay the loan off? 

All retirees can 'carry' their loans into retirement at the same monthly repayment level as when they were an active member (Biweekly loan payments are converted to monthly payments by multiplying the biweekly payment by 2.175). The member can still pay off the loan in a lump sum. Interest will continue to accrue at 4.00% if the member chooses to 'carry' the loan.

Line 12 - Are you currently under departmental charges of formal indictment?  

If the member is under charges or formal indictment, additional information will be required from the employer and/or the member. Delay in receiving this information could delay the processing of the member's pension.

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Lines 13 and 14 must be answered for Accidental Disability only.

Line 13 - Date of Accident and Description:  

The date of accident will be the date of the traumatic event that directly caused the totally and permanently disabling condition.  

The accident description and list of witnesses provides the member the opportunity to tell in his or her own words valuable information that may prove helpful in determining eligibility for accidental disability retirement.  

Line 14 - Has a Claim Been Filed for Workers' Compensation?  

If yes, then the member must attach a copy of the award. The member should complete questions 14a, 14b and 14c:

  • Amount of Periodic Benefits (stated as a weekly dollar amount), 
  • Beginning date of award (when the award was effective) and 
  • Ending date of award (when the award's benefit concludes).

If the member has filed for Workers' Compensation and the award is still pending, the member should forward the information to the Division as soon as possible. (See Fact sheet #45)

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Part Two: Marital Status and Children

Line 15:     

Indicate Here the Member's Marital Status.

Line 16 - Name of Spouse:

Blank or N/A if none. This information is needed for the letter to the member's spouse notifying the spouse if the member takes the Maximum Allowance pension benefit (sent Certified mail). Divorced, or ex-spouses, do not need to be listed.

Line 17 - Spouse's Social Security Number: 

Not required, but will help to expedite benefit processing at the time of member's death

Line 18 - Spouse's Address:  

Only needed if it is different than the member's mailing address.

Line 19 - Name, Gender and Birth date of Eligible Dependent Children:

List all dependent children under age 18, or who are mentally or physically handicapped regardless of age.  Copies of birth certificates, adoption papers, and medical documentation proving disability are required for each child listed.

If additional space is needed, the member may attach additional sheets.  If additional sheets are needed to list dependent children, these also must be notarized.

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PART THREE: Designation of   Group Life Insurance Beneficiary

Line 20. Primary Beneficiary(ies): 

The primary beneficiary(ies) listed will receive the member's group life insurance. The coverage amount varies according to the fund and level of coverage as an active member. 

The following information is needed: Beneficiary's Name, Address, Date of Birth and the beneficiary's Relationship to the member (spouse, daughter, son, father, mother, friend, grandchild, etc.).

If the member chooses multiple primary beneficiaries and one beneficiary predeceases the member, the remaining beneficiary(ies) will usually split that beneficiary's share. Some unusual designations are allowable, but uncommon. Unless otherwise stated, if there are multiple beneficiaries listed, they are considered "share and share alike."

Line 21 - Contingent Beneficiary(ies):

In the event all primary beneficiaries have predeceased the member, the group life insurance benefit will be paid to all listed contingent beneficiaries on a "share-and-share-alike" basis, unless otherwise provided for.  

In the event all contingent beneficiaries have also predeceased the member, the group life insurance benefit will be paid to the member's estate.

The following information is needed: Beneficiary's Name, Address, Date of Birth and the beneficiary's Relationship to the member (spouse, daughter, son, father, mother, friend, grandchild, etc.).

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Member Signature

The member must sign the application.


Instructions for the Employer Certification for Disability Retirement

Instructions for Employer Certification for Disability Retirement

Line 1 

Please check to appropriate box denoting the Pension Fund the member belongs to.

Line 2 

This is self explanatory. Include name of the Employee, Job Title (including a copy of the job description), Social Security Number, Name of employing location, employer address and phone number.

Type of Disability Retirement: Check to box that corresponds to the type of Disability Retirement the member is applying for.

Line 3 - Employee Status

Please check the box that is appropriate. To determine full-time status, refer to the regulations that pertain to your location. For example, 35 or 40 hours per week.

Line 4 - Authorized Leave of Absence

Review attendance records to determine if the member has been on an authorized leave of absence within the past year. Please check all that apply. This will help the Division of Pensions to determine the member's final salary.

Line 5 - Unauthorized Leave of Absence

Please indicate if the member was out on an unapproved leave and, if so, the duration of the leave.

Line 6a - Is the member currently on suspension?

It is very important that you answer this question, even if the answer is "No". If the answer is "Yes", be sure to include the date of suspension and any documents that describe the reasons and circumstances surrounding the suspension. By law, the Division cannot process a retirement unless and until all information concerning suspensions are submitted. Be sure to indicate if a suspension is paid or unpaid.

Line 6b - Is the applicant facing disciplinary action or indictment?

Again, it is essential that you answer this question, even if the answer is "No". If the answer is "Yes", you must attach copies of all documents that pertain to the disciplinary action or indictment, including preliminary and final notices of disciplinary action or their equivalents.

Failure to answer questions 6a and 6b will only delay the processing of the applicants retirement.

Line 7 - Was the applicant dismissed?

As with lines 6a and 6b, this question must be answered "yes" or "no". If yes, you must give the reason and date of dismissal. This may have a direct bearing on the outcome of the member's application for retirement.


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Line 8 - If the employee is filing for an Accidental Disability Retirement

Since an Accidental Disability Retirement is granted only for those who suffer a "Traumatic Event" during the course of regular job duties, accident reports taken by the employer are exceptionally important. Please answer the questions on the basis of official records relating to the accident.

Be sure to include copies of any pertinent documentation including an accident report, witness statements, etc.

The question concerning Workers' Compensation is very important. If a case has been settled or is still pending, please attach a copy of all documentation you may on file. This is essential information that may corroborate the applicant's eligibility for Accidental Disability Retirement, and may influence the calculation of the member's retirement allowance.

Line 9 - Date employee's service terminated

This is the last date on which the employee earned or will earn salary from employment.

Line 10 - Base Salary subject to pension fund contributions

Last 12 months (10 months if applicable) of salary must be indicated. Salary should be reported by the number of months at a given salary, the amount of the monthly base salary, the beginning and ending dates of that salary and the total base salary for the period. Salary beyond the last reported quarter is to be projected to the best of the employer's ability.

Line 11 - Has the member received an annual salary increase of 10% or more in the last 3 years?

If the answer is yes, the employer must furnish cause for the increase, with documentation. The Division may approve the increase, if justifiable, deny the increased salary, or forward the case to the Board of Trustees for determination.

Line 12 - Retroactive salary increases in last three years

A retroactive salary increase can falsely inflate a member's salary if it is not properly credited back to the correct dates. Retroactive salaries can also incorrectly show a single salary increase, when in fact it may cover several years of increases. The beginning and ending dates should show for each retroactive increase and the corresponding new annual base salary.

If the member receives a retroactive raise after the original Certification has been sent to the Division, a new Certification must be sent in. The new Certification should state 'Amended' or 'Revised for Retroactive Raise.'


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Line 13 - Salary Deductions during final quarters

The employer indicates the actual and/or projected base salary subject to pension contributions for the last two quarters preceding the member's termination date. Also noted in this section are the amounts of actual and/or projected payroll deductions for: Pension Contributions, Loan Repayment, Back Deductions (including the number of payments taken), Arrears (and/or Purchases) deductions, and the Total Pension Deductions taken (and/or projected to be taken) by the employer and remitted to the Division for this member.

State employers must attach a screen print of the member's TREADHOC biweekly certification with salaries projected until termination date in lieu of completing Item 11.

Checklist

This is a helpful tool to remind you which forms and documents to include with the Disability Retirement Certification.

Enclose a letter addressed to the Division of Pensions and Benefits stating that, in the employing authority's opinion, the member is "totally and permanently disabled" from fulfilling his or her job duties.

Name and Signature of the Superintendent of State Police

The Superintendent of State Police must sign this form. This signature must be an original signature and can not be a stamped signature.

The date signed is helpful in processing a retirement: when more than one Certification is received, the Division can ensure that the most recent Certification is used for processing. Usually more than one Certification is received when there is a retroactive salary increase, or a correction is made for erroneous information.

The Medical Examination by Personal or Treating Physician Form

 

Instructions for the Medical Examination By Personal or Treating Physician Form

  • The applicant must complete Part One and submit the form to the physician(s) who were or are involved in treating the disabling condition.  
  • A copy of the job description may prove helpful to the physician as the assessment for this form is made.  
  • If more than one physician's statement is needed, the applicant may make as many copies as necessary.
  • While copies of this form are permitted, they must be double sided copies of the original.

    After completing Part Two, the physician may forward the form directly to the Division of Pensions and Benefits at the address listed on the top of the first page.  Or it may be submitted with the Disability Retirement application by the member.

    It is essential that all relevant medical information be submitted to the Disability Review Section at the Division of Pensions and Benefits before adequate determination of eligibility for Disability Retirement can be made.  Any delay in receiving this (or any) form will only delay processing of the retirement.

 

The Authorization for Release of Medical Records

Instructions for the
"Authorization for Release of Medical Records" Form

Medical records pertaining to any hospitalization(s) related to the disabling condition must also be submitted to the Division of Pensions and Benefits.

  • If no hospitalization occurred, then medical examination reports from at least two physicians must be submitted before a determination of disability can be made.  This form is still required by the Division of Pensions and Benefits even if there was no hospitalization.
  • The member may make as many copies of this form as necessary in order to obtain records from more than one hospital.
  • The member must submit this form directly to the hospital requesting the needed records.
  • The member also assumes all responsibility for any charges levied by the hospital for reproducing and/or forwarding these records to the Division of Pensions and Benefits.

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Last Updated: October 30, 2013