RETIREMENT PLAN ELECTION FORM Human Resources Department Administration and Finance University of Cincinnati PO Box 210039 Cincinnati OH 45221-0039 Phone: 513-556-6381 You have 120 days from the date of your eligible employment to submit this form to the Central HR/Benefits Department. Submit the form to benefits@uc.edu or to the addressabove. Retain a copy of this form for your records. A confirmation email will be sent when the form has been received. 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 applicable. Contact the UC Benefits Office at benefits@uc.edu with any questions.
Instructions:
SECTION 1: PERSONAL INFORMATION – Please type or print.
Employee’s FullName:First
M.I.
Last
Social Security Number(required) Social Security Number
Home Mailing Address: Street
City
State
Zip
Date of Hire
Date of Birth
Gender
UC ID (required) (required)
Are you currently receiving a retirement benefit from any State of Ohio retirement system? STRS Have you previously had the option to elect the Alternative Retirement Plan in the State of Ohio? If no, continue to Section 2. If yes, which system? OPERS SERS Ohio?
Yes
No
Yes
No
If no, continue to Section 2. If yes, date of previous eligibility:
at (name ofschool): school):
SECTION 2: ELECTION OF RETIREMENT PROGRAM (choose only one)
I elect to participate inthe state
I elect to participate in the ARP. Select one of the following ARP providers.
retirement system for which I am eligible* 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 date to select one of three options within either STRS or OPRS. Contact STRS or OPERS for details.
AXA/Equitable Fidelity TIAA-CREF VOYA
I understand the mitigating rate applied to the employer contributions is subject to increase or decrease based on applicable law and retirement system mandates.
If you elect to participate in the ARP, but you do not chose an ARP account provider and/or open an account with that provider, a default provider and/or default investment will be selected for you. You will have the opportunity to change your default provider and/or default investment at any time.
SECTION 3: AUTHORIZATION ION
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 ARP provider and failure to do so will result in my contributions being sent to the default providers and investments. 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. University of Cincinnati. I also understand that by electing to participate in understand that I will be able to make an election to participate in time by another Ohio public institution of higher education in a position for which a retirement election is available.
Signature (Digital or electronic signatures not accepted.)
Date
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. The Central Human Resources Department must receive your completed form by 5 p.m. EST on the last business day before the 120 th day. Refer to the ARP Deadline Calendar (http://bit-ly/uc-benefits). for your 120th day deadline.
Annual Compensation Employee Contributions
Applicable StateSystem: Date eligible for ARP: Date from received: Certified by Title
-
-9430
Total EmployerContributions LessSupplemental Contribution
contributions to applicable state system Employer Contribution to ARP Provider Date of last payroll report with employee
10/2020 (rev)
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