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CMERS Online Survey

Please be advised that the State Employees Retirement Commission (Commission) voted to clarify that the law states that an individual cannot receive a Connecticut Municipal Employees Retirement System (CMERS) pension benefit if he/she becomes reemployed for twenty (20) hours or more per week or more than ninety (90) working days in one calendar year, with the same municipality or any other municipality participating in CMERS, even if reemployed in a position that is not covered by CMERS.

As a result of this action, each CMERS retiree must complete the affidavit below, or the paper form that was received in the mail, to confirm whether or not he/she is reemployed with a municipality that participates in CMERS. Please carefully read and complete the affidavit online or complete and return the form that was mailed to you either by mail or by fax at (860) 702-3571 no later than March 1, 2016. Failure to respond by March 1, 2016 may result in suspension of your retirement benefit.

Please note that, in addition to submitting the affidavit at this time, you must notify the Retirement Services Division immediately of any type of reemployment or change in employment in order to prevent an overpayment of retirement benefits, which would require repayment by you.

Any questions you have concerning this matter may be directed to CMERS at (860) 702-3500. Thank you for your cooperation.

* Required

Last Name*

First Name*

Daytime Phone Number*




Zip Code*

Certification of Reemployment After CMERS Retirement

Please check the appropriate box below

   I am NOT currently reemployed with a Municipality.

  I AM currently employed with a Municipality BUT:
     I am working for less than twenty (20) hours per week; or
      I am employed for no more than ninety (90) working days in one calendar year.

      Name of Municipality where reemployed:


  I AM currently reemployed with a Municipality for:

     More than twenty (20) hours per week; or
     More than ninety (90) working days in one calendar year.

     Name of Municipality where reemployed:


Certification by CMERS Member

*I certify that, to the best of my knowledge, the following are true and accurate statements regarding my employment after my CMERS Retirement and that any false or misleading statements or omissions of material information with regard to the questions asked on this form may adversely affect the continued receipt of my retirement benefit.

Enter your name*:


Enter today's date*:



If you prefer to send this affidavit by mail, rather than online, please send to:

Office of the State Comptroller
55 Elm Street
Hartford, CT 06106

Forms may also be faxed to (860) 702-3571.

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