CalPERS and CalSTRS Retirement Forms Examples …

1 CalPERS and CalSTRS Retirement Forms Examples Handout SDCOE Retirement Reporting Forms and Documents Website: services/financial services/ Retirement . reporting/Pages/ Retirement reporting Table of Contents CalPERS Reporting Forms : 2) CalPERS AESD 2 Member Action Request for "0269 San Diego County Schools" New Appointment 3) CalPERS AESD 2 Member Action Request for "0269 San Diego County Schools" . Permanent Separation CalPERS AESD 2 Member Action Request for "0246 San Diego County Office of Education" District 099 Use Only. Please refer to Examples on 3 4) CalPERS AESD 139 Notice of Exclusion from CalPERS Membership 5) CalPERS CASD 801 Reciprocal Self Certification form 6) CalPERS 2190 Address Change Authorization (For Retirees Use) 7) CalPERS MEM 1344 Request for Payroll Information CalSTRS Reporting Forms : 8) CalSTRS ES0350 Permissive Membership 9) CalSTRS ES0372 Retirement System Election 10) CalSTRS ES1161 Reduced Workload Program Eligibility Certification ( form located under SDCOE Retirement Reporting Bulletins and Correspondence.

2 CalSTRS Reduced Workload Program Contracts for 2016/2017 05/10/2016 Revised) 11) CalSTRS RF 1360 Refund Application 16) Certification of Freedom from Contagious or Infectious Disease 1 SDCOE Retirement Reporting Unit Revised 04/04/2017 2 SDCOE Retirement Reporting Unit Revised 04/04/2017 3 SDCOE Retirement Reporting Unit Revised 04/04/2017 4 SDCOE Retirement Reporting Unit Revised 04/04/2017 5 SDCOE Retirement Reporting Unit Revised 04/04/2017 6 SDCOE Retirement Reporting Unit Revised 04/04/2017 7 SDCOE Retirement Reporting Unit Revised 04/04/2017 8 SDCOE Retirement Reporting Unit Revised 04/04/2017 9 SDCOE Retirement Reporting Unit Revised 04/04/2017 10 SDCOE Retirement Reporting Unit Revised 04/04/2017 11 SDCOE Retirement Reporting Unit Revised 04/04/2017 12

3 SDCOE Retirement Reporting Unit Revised 04/04/2017 13 SDCOE Retirement Reporting Unit Revised 04/04/2017 14 SDCOE Retirement Reporting Unit Revised 04/04/2017 15 SDCOE Retirement Reporting Unit Revised 04/04/2017 16 SDCOE Retirement Reporting Unit Revised 04/04/2017