Human Resources Department Administration and Finance University of Cincinnati PO Box 210039 Cincinnati OH 45221-0039 Phone: 513-556-6381
RETIREMENT PLAN ELECTION FORM
• You have 120 days from the date of your eligible employment to submit ORIGINAL of this form to the Human Resources Department. • If you wish to elect OPERS or STRS, simply check the appropriate box in Section 2 below. • If you wish to participate in the Alternative Retirement Plan (ARP), check the appropriate box in Section 2 below and select one of the providers.
• If you do not make an election during the 120-day period, you will default to OPERS or STRS, as appropriate. Contact the Human Resources Department at Keisha James at 513-556-2446 or firstname.lastname@example.org with any questions.
SECTION 1: PERSONAL INFORMATION
Employee’s Full Name: First
Social Security Number (required)
Home Mailing Address: Street
Date of Hire
Date of Birth
UC Employee ID# (required)
Are you currently receiving a retirement benefit from any State of Ohio retirement system?
If no, continue to Section 2. If yes, which system? STRS Have you previously had the option to elect the Alternative Retirement Plan in the State of Ohio? OPERS SERS
If no, continue to Section 2. If yes, date of previous eligibility:
at (name of school):
SECTION 2: ELECTION OF RETIREMENT PROGRAM (choose only one)
I elect to participate in the state
I elect to participate in the ARP. (Select one of the following ARP providers.) You MUST contact your chosen provider in order to complete the enrollment.
retirement system for which I am eligible*
AXA/Equitable Fidelity TIAA-CREF VOYA
• STRS for eligible faculty • OPERS for eligible staff
I understand that by electing to participate in a state retirement system, I am irrevocably waiving my right to participate in the Alternative Retirement Plan while I am continuously employed at the University of Cincinnati. *If you choose a state retirement system, you have 180 days from your eligibility to select a retirement system plan option. Contact STRS or OPERS for details.
ARP Account Number/Plan ID# (last four digits only) : _____________________
SECTION 3: AUTHORIZATION
I understand that by electing to participate in the ARP I am irrevocably waiving my right to participate in the eligible state retirement system while I am employed at the University of Cincinnati. I also understand that by electing to participate in the ARP, I will be forever barred from claiming or purchasing service credit under any state retirement system for the period that an election to participate in the ARP is effective. I must complete an enrollment application to activate an account with my selected ARPprovider. I hereby certify the election chosen above in Section 2. I understand that I will be able to make an election to participate in another ARP or Ohio public retirement System if I cease to be employed for at least 365 days or am subsequently employed full-time by another Ohio public institution of higher education in a position for which a retirement election is available.
Date The Human Resources Department must receive your completed form by 5pm EST on the last business day before the 120 th day. Refer to the ARP Deadline Calendar (http://www.uc.edu/hr/benefits.html) for your 120 th day deadline.
FOR OFFICE OF HUMAN RESOURCES USE ONLY
For ARP Elections Only. Contributions made to the applicable state system during the election period to be forwarded to the ARP Provider. Annual Compensation Applicable State System: □ OPERS-1630 □ STRS Ohio-9430 Employee Contributions Date eligible for ARP: Total Employer Contributions Date from received: Less Supplemental Contribution Certified by Employer Contribution to ARP Provider Title
Date of last payroll report with employee contributions to applicable state system
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