--------------------The United Federation of Teachers in District 11 -------------------------------------Alice Cooper-Jackson, District Representative---------------------

Pension Forms

ACCOUNT STATEMENTS

ABS Reprint Request Form (11/02) - DM32
1099-R / 1099-INT Inquiry Form (1/05) - GA5
QAS Inquiry Form (12/01) - MA3
QAS Reprint Request Form (6/06) - MA4
QAS / ABS Request Form (For Members who are on a Leave of Absence) (8/02) - MA11
ABS Inquiry Form for Tiers I/II Members (10/05) - SD12-I/II
ABS Inquiry Form for Tiers III/IV Members (10/05) - SD12-III/IV

ADDRESS / NAME CHANGE

Member's Change of Address Form (5/07) - DM13
Beneficiary's Change of Address Form (11/04) - DM14
Retiree's Change of Name Form (9/98) - RP1

BENEFICIARY DESIGNATION For In-Service Members
	Designation of QPP Beneficiary Form (For In-Service Members Under the Qualified Pension Plan) (9/98) - EN6/EN6i
	Additional QPP Beneficiary Form (For In-Service Members Under the Qualified Pension Plan) (9/98) - EN7
	Designation of TDA Beneficiary Form (11/04) - EN8
	Additional TDA Beneficiary Form (Attachment to "Designation of TDA Beneficiary Form") (11/04) - EN9

BENEFICIARY DESIGNATION
For Retiring Members

Retired / Retiring Member's Additional QPP Beneficiary Form (9/98) - EN22
Retired / Retiring Member's Additional TDA Beneficiary Form (9/98) - EN23

BENEFICIARY DESIGNATION For Retirees
	QPP Change of Beneficiary Form Under Option IV-d or IV-e (Tiers I/II) or Option 3 or 4 (Tiers III/IV) (9/98) - EN18
	QPP Change of Beneficiary Form Under Option I (Modified or Unmodified) or IV-b (9/98) - EN19
	TDA Change of Beneficiary Form Under Option I (Modified or Unmodified) or IV-b (9/98) - EN20
TDA Change of Beneficiary Form Under Option IV-d or IV-e (9/98) - EN21 QPP Change of Fractional Beneficiary Form (9/98) - EN24 TDA Change of Fractional Beneficiary Form (9/98) - EN25
	Change of Beneficiary Form for the Post-Retirement Death Benefit under Death Benefit #2 (9/98) - EN34


BENEFICIARY DESIGNATION For Beneficiaries
	Beneficiary's Designation of Beneficiary Form (For Fractional Installment of Continuing Allowance) (9/98) - DB16
	Beneficiary's Additional Beneficiary Form (9/98) - DB29
	Designation of TDA Beneficiary Form (11/04) - EN8
	Additional TDA Beneficiary Form (Attachment to "Designation of TDA Beneficiary Form") (11/04) - EN9

DEATH BENEFITS Confirmation of Member's Death Form (9/98) - DB2b Confirmation of Beneficiary's Death Form (9/98) - DB3b Beneficiary's Election Form for Method of Payment (10/98) - DB12 Option IV-b Election Termination Form (9/98) - DB13 Benefit Claim Form Under Section 1310 (8/03) - DB14 Claimant's Statement (7/04) - DB17 Release of Claim Form Under Section 1310 (9/98) - DB28
	QPP Direct Rollover Election Form (For Withdrawal/Distribution of Lump-Sum Disability Benefit/Death Benefit) (9/02) - DB32
	TDA Direct Rollover Election Form (For Lump-Sum TDA Death Benefit (For Spouse Beneficiaries Only)) (11/04) - DB34a
	TDA Direct Transfer Application (For Lump-Sum TDA Death Benefit (For Non-Spouse Beneficiaries Only)) (11/04) - DB34b


LOANS QPP Loan Application (6/07) - LO6 QPP Loan Repayment Request Form (6/05) - LO11q TDA Loan Repayment Request Form (11/03) - LO11t TDA Loan Application (6/07) - LO15
	TDA Loan Immediate Repayment Form (For Members who are on a Leave of Absence) (9/98) - LO29
QPP Loan Direct Rollover Election Form (12/01) - LO57/LO57i TDA Loan Direct Rollover Election Form (12/01) - LO58

MISSING CHECKS

Affidavit for Forged Check (9/00) - BK1
Affidavit for Missing Check (and Authorization to Stop Payment) (9/00) - BK2
Affidavit for Check Lost After Receipt (and Authorization to Stop Payment) (9/00) - BK3
Check Reissue Request Form (9/00) - BK6

PAYROLL DEDUCTIONS AND DEDUCTION CHANGES

QPP Contributions Change Application (For Tier I and Tier II Members Only) (12/01) - IP1
Erroneous QPP Loan Payment Refund Application (10/99) - IP4
Erroneous TDA Loan Payment Refund Application (10/99) - IP11
Erroneous QPP Contribution Refund Application (8/99) - IP12
Zero Rate Application (For Tiers I/II Members Only) (7/03) - RW73
Erroneous TDA Contribution Refund Application (8/99) - TD60

POST-RETIREMENT

Account Number Change Form (6/05) - BK11
EFT / Direct Deposit Cancellation Request Form ( 6/05) - BK19
Renewal Affidavit of General Power of Attorney (9/98) - BK30
EFT Authorization Form (6/07) - BK58
Application for Voluntary Restoration from Disability Retirement (9/98) - DI20
Application for Restoration from Service Retirement (9/98) - GA1
Certification of Employment Under Section 212 (1/03) - IA8
Report of Income Earned Before Retirement (3/04) - IA20
Retirement Allowance Suspension/Resumption Form (1/03) - IA22
Benefits Letter Inquiry Form (9/98) - RC1
QPP Retirement Payment Option Change Form For Tiers I/II Members Only (1/04) -RW86

PRE-RETIREMENT
Benefit Estimates Request by Members With Deferred Payability (7/03) - RW6

QPP ENROLLMENT

Tiers III/IV Enrollment Application (1/06) - EN10
Transferred Contributor Election Form (7/07) - EN17

TRS Enrollment Application (For Paraprofessionals/CUNY Instructional Staff Electing to Join TRS) (2/06) - EN56

QPP WITHDRAWALS

QPP Direct Rollover Election Form (6/03) - RW29
Application for Withdrawal of QPP Accumulations (6/03) - RW41
Excess Withdrawal Application (For Tier I and Tier II Members Only) (10/98) - RW74)

SERVICE CREDIT

Military Service Credit Request Form (7/01) - SD68
Chapter 126 Inquiry Form (7/02) - SD95
Record of Prior and/or Transferred Service Form (4/07) - (SB146)

TDA PROGRAM

TDA Annuitization Option Change Form For Tiers I/II Members Only (1/04) - RW87
TDA Direct Transfer Application (7/04) - TD15
TDA Direct Rollover Election Form (7/04) - TD22
TDA Beneficiary Transfer Application (1/07) - TD22B
TDA Deferral Status Election Form (For Retiring Members) (9/98) - TD30
TDA Deferral Status Election Form (For Vested Members) (9/98) - TD31
TDA Withdrawal Application (11/02) - TD32/TD32i
TDA Withdrawal Application for Beneficiaries (1/07) - TD32B
RMD Election Form (3/07) - TD39
TDA Hardship Withdrawal Application (10/06) - TD44
TDA Rate Review Request Form (10/02) - TD49
RMD Election Form For Beneficiaries (12/06) - TD85

MISCELLANEOUS

Special Medical Committee Request and Waiver of Rights (9/98) - DI17
Account Information Access Form (4/04) - DM11
Filing Intent Form (7/02) - DM30
Verification of Trust Instrument Legality (6/06) - EN4
Affidavit for Non-TRS Transferred Contributors (1/99) - EN40
Withholding Election Form (8/99) - IP17
Request for Withdrawal of Form / Application (9/98) - MI5
Authorization to Pick Up Check (7/06) - MS3
TRS Membership Transfer Form (7/03) - RW39
Multiple Employment Membership Status Employment History Data Form (4/06) - RW67
Membership / Tier Reinstatement Request Form (6/03) - SD42