Request for Retirement Counseling

2. Instructions and Important Information: 

    

   Please complete all sections of the form to the best of your knowledge. Staff will complete a thorough review of your account and verify all compensation and creditable service. All retirement calculations are estimates and subject to change after final pay data is audited. All final benefit calculations are submitted to the Public Employees Retirement Administration Commission (PERAC) for final approval. 

4. Full Name
6. Phone
7. Email
9. Position
10. Department
12. Goal or Estimated Dates of Retirement
13. Goal or Estimated Dates of Retirement
15. Requested Meeting Dates
16. Requested Meeting Dates

18. Note: Your estimated dates of retirement or goal for retirement will be used for benefit projections ONLY. This does not constitute an application for retirement or notification of separation with your employer. 

20.          SECTION I:    CREDITABLE SERVICE INFORMATION 

22. Employment Percentage (Please select one)
    -- Select One --Always Full-time (100%)Mix of Part-time and Full-timeAlways Part-time
24. Current Employment Status
    -- Select One --Active- Currently EmployedInactive - Funds still on account - not employed Leave of Absence (paid or unpaid)Worker's Compensation Section 111F - Public Safety Only
26. If applicable, during membership with the Stoneham Retirement System, I had a break in service, worker’s compensation, or a leave of absence on the approximate dates (List all that apply):

28.      SECTION II:  ACKNOWLEDGMENT OF STATEMENTS BELOW 

30. PLEASE CHECK THE BOX next to each statement below acknowledging you read the statements

    1. Submitting this form does not take the place of filing a notice of intent to retire with the retirement system nor your employer (Town of Stoneham or Stoneham Housing Authority) A completed retirement application is required to initiate benefits. The deadline to file a retirement application is 60 days after your date of separation to be paid retroactively to your date of separation. If inactive you must file at least 15 days prior to your intended retirement date
    2. If a member works part-time for their entire career the member will receive one year of creditable service for each full year in which they receive regular compensation. If a member works a combination of full-time and part-time, the part-time service will be pro-rated based on the full-time equivalency of the weekly hours required for the position, which is typically 30 (10-month), 35, 37.5 or 40 hours per week. All members in service as of 2/11/2004 (who have not refunded) receive FTE credit.
    3. Earnings that qualify as regular compensation are determined pursuant to Massachusetts General Law Chapter 32 Section 1 and PERAC 840 CMR 15.03 Regular Compensation. Amounts determined to be regular compensation are subject to retirement deductions and are allowable in your final average salary period.
    4. Benefit projections for retirement are estimates and subject to change. Salary experience can differ from year to year when projecting future salary data. Future breaks in service may also lead to differences in your final benefit calculation.
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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