Summary of Forms and Documents Required
to Process Retirement Applications
COMPLETED FORMS REQUIRED
- Application for Retirement Benefits: Form CO-898 (Refer to Memorandum
dated March 31, 1989, entitled "Retirement Applications".);
- Income Payment Election Form (Option): Form CO-899, CO-900, CO-901 or
- Spouse Waiver of Monthly Survivor Benefits: Form CO-1047 Note: Do not let
title of the form confuse you - the CO-1047 must be executed for both
married and single employees. (Refer to memorandum dated January 25, 1990,
entitled "Form for Spouse Waiver of Monthly Survivor Benefits".)
The term "spouse" is also intended to mean a same sex domestic
partner who has executed an "Affidavit of Domestic Partnership"
(Form CO-1049) with the Division. Refer to Comptroller's Memorandum No.
2000-13, dated March 10, 2000, entitled "Health Care and Pension
Benefits for Same Sex Domestic Partners of State Employees and
- Choice of Health Services after Retirement: Form CO-744 (Refer to
memorandum dated May 24, 2002, entitled "Choice of Health Services
After Retirement".) Additionally, copies of Medicare Part B cards for
both the member and spouse should be provided, as applicable, with the Form
- Federal W-4P;
- State CT-W-4P (Refer to memorandum dated December 26, 1991, entitled
"Withholding of Connecticut State Income Tax".);
DOCUMENTATION REQUIRED OF THE EMPLOYEE
- Copy of member's birth certificate or acceptable substitutes with
affidavit. Please refer to Attachments "G" and "H" for
- For married members, (a) copy of spouse's birth certificate or acceptable
substitutes with affidavit and (b) copy of marriage certificate.
- Where named contingent annuitant is other than a member's spouse, a copy
of said annuitant's birth certificate or acceptable substitutes with
DOCUMENTATION REQUIRED OF THE AGENCY
- For hazardous duty members, copy of roster cards reflecting all positions
held in state service which are required to meet twenty year threshold with
cover letter listing positions in chronological order. (Refer to Memorandum
dated March 25, 1996, entitled "Applications for Hazardous Duty
Benefits from SERS").
- For members using accrued vacation time to meet the eligibility threshold,
copies of attendance records for 2003 reflecting leave balances that serve
to bridge minimum service requirements.
- For laid-off employees, a copy of the notification of layoff.
- A salary history for any member for whom such salary information was not
reported to the Automated Personnel System (APS). The history should include
salary amounts, reasons for salary changes and the effective dates of such
If any documentation is submitted under separate cover, the
member's name, employee number, and date of retirement must appear on each
Return to 2003 ERIP memo
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