| ACTIVE MEMBERS |
 |
 Contribution Balance Request - A3 |
| Use this form if you need the amount of contributions you have paid into the system as of today. |
| Disability Application Packet |
| Use this application to apply for Disability benefits. |
| Disability Authorization to Release Information |
| DROP Application |
| Use this form if you would like to enter the DROP Program. |
| Military Purchase Application |
| This form is for getting a cost to purchase your military service, a copy of your DD214 papers are required. |
| Personal Information Changes |
| If you need to make any changes to your retirement account including address change, marital status, beneficiary change, etc., please complete this form. It must either be mailed or faxed. |
| Reciprocal Recognition |
| If you would like to enter into a reciprocal recognition with MERS and another Louisiana public pension fund which you have service credit, complete this form in triplicate and mail to MERS, 7937 Office Park Blvd., Baton Rouge, LA 70809. |
| Refund Application - Mandatory Direct Deposit |
Use this form for refunds of contributions. Effective March 1, 2014 all refunds must be direct deposit. No exceptions. If this form is not properly completed and signed, your refund will be delayed. DO NOT USE THIS FORM FOR SURVIVOR REFUNDS. If you are rolling over the taxable portion of your employee contributions, please complete "Rollover of Refund" form below.
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| Repayment of Refund Calculation |
If you would like to receive an
invoice with the amount you would need to pay to restore service credit
with MERS that was previously refunded, complete this form.
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| Retire from DROP Application |
| If you are currently participating in DROP and decide to retire before you have completed the length of participation you applied for, please complete this form. |
| Retirement Application |
| Please use this form when you want to apply for retirement benefits. Preferably 2 months before your actually retirement date. After completing your portion and attaching all required documentation, bring to your human resources department for final completion. Applications received without the proper paperwork will delay processing. |
| Retirement/DROP Estimate Form |
If you want an estimate of your
retirement benefit, DROP benefit, or your additional benefit when you
retire after continuing to work after you have completed the DROP
program.
Estimates may be requested within 3 years of eligibility.
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| Rollover of Refund |
| If you wish to rollover your sheltered contributions to another qualified plan when you terminate employment with your municipality, you must complete this form. This form along with your financial institution's "Request to Transfer" form must be attached to your completed refund application.
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| Spousal Consent Form |
| This form must be attached to your retirement or DROP application if you have a legal spouse and you are choosing the Maximum Benefit. It does not need to be completed if you are leaving your spouse at least 50% of your retirement benefit. Please note that this form must be notarized or it will be returned and your application process will be delayed.
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| Survivor Benefits Application |
| Use form to apply for survivor benefits when an active member deceases. Please call the office with any questions. |
| Survivor Refund Application |
| Use this form for refunds of contributions to survivors of deceased members. |
| Transfer of Service Credit |
If you have service credit with
another Louisiana public pension fund, you are eligible to request a
transfer of service credit after you have contributed to MERS for six
(6) months.
|
| Trustee Transfer Form |
| This is to be used to repay a refund or pay for a transfer of service credit with sheltered funds you may have in a qualified plan. |
| Unclaimed Contributions Application |
Use this form if you have located funds available on the LA Treasurer's "Unclaimed Property" website.
No information will be given over the telephone or through email. This form must be received by our office with the proper documents attached before any information is released. This process may take 2-3 months to complete.
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| RETIRED MEMBERS |
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| Direct Deposit Form |
| To be used to either begin electronic deposit of your benefit check or to change your bank and/or account number to your checking or savings account. |
| Drop Distribution
|
This form is to be completed if you would like to withdraw funds from your DROP account. Please note that withdrawals are only processed on the first of each month. This form must be received in our office no later than the 20th of the month to be processed by the 1st of the following month.
You would also use this form to rollover your funds into another qualified plan.
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| Drop Distribution - Survivor |
This form is to be completed by a survivor of a member to withdraw funds from the member's DROP account. Please note
that withdrawals are only processed on the first of each month. This
form must be received in our office no later than the 20th of the month
to be processed by the 1st of the following month.
You would also use this form to rollover your funds into another qualified plan. |
| Earnings Limit Request |
| To get the amount you can earn if you return to employment with a municipality in our system after you have retired. |
| Income Verification |
| If you are retired and you need income verification, please complete this form. |
| Retiree Important Reminders |
| Please read to keep updated on your responsibilities after retirement. |
| Retiree Update Form |
Use this form to update your mailing address for mail outs, correspondence and annual 1099’s. This form should also be used to report the death of your beneficiary.
|
| Special Tax Notice |
| This notice explains your federal tax obligation when you withdraw funds from your DROP account. |
| W4P |
| IRS W4P is used to change your federal income tax withholdings from your retirement benefit.
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| EMPLOYERS |
| |
| Conversion of Unused Leave |
| If your employer converts unused and unpaid leave upon retirement, this form must be completed and returned with the member's retirement application. |
| Enrollment Form |
To enroll all new full-time employees or rehired employees into the retirement system.
THIS FORM MUST BE EITHER FAXED OR MAILED. DO NOT EMAIL.
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| Forfeiture of Benefits Attestation |
| This is to be completed by all new employees hired January 1, 2013 to date. DO NOT MAIL THIS FORM TO THE RETIREMENT SYSTEM. IT MUST BE KEPT IN THE EMPLOYEE'S PERSONNEL FILE WITH THEIR EMPLOYER. |
| Municipality Contact Designation |
| This form is to be completed by the Mayor designating the Authorized Representative to certify employee information (applications, enrollment forms, refunds, etc.) and to designate one employee to receive all correspondence from this office to be distributed to the proper department. |
| Municipality Information |
| Please keep us updated with all changes of municipal contacts, address, etc. |
| Plan A DROP Monthly Report 7/1/16-6/30/17
PDF Format |
To report monthly DROP employee salaries and employer contributions.
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| Plan A DROP Monthly Report 7/1/17-6/30/18 |
To report monthly DROP employee salaries and employer contributions.
Fiscal Year 7/1/17 - 6/30/18
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| Plan A Monthly Report 7/1/16-6/30/17
PDF Format |
To report monthly employee salaries and employee and employer contributions.
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| Plan A Monthly Report 7/1/17-6/30/18 |
To report monthly employee salaries, employee, and employer contributions.
Fiscal Year 7/1/17 - 6/30/18
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| Plan A Retirees Returning to Work Monthly Report 7/1/16-6/30/17 PDF Format |
| To report monthly retirees that have returned to work salaries, employee, and employer contributions.
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| Plan A Retirees Returning to Work Monthly Report 7/1/17-6/30/18 |
| To
report monthly retirees that have returned to work salaries, employee,
and employer contributions. Fiscal Year 7/1/17-6/30/18
|
| Plan B DROP Monthly Report 7/1/16-6/30/17
PDF Format |
To report monthly DROP employee salaries and employer contributions.
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| Plan B Monthly DROP Report 7/1/17-6/30/18 |
To report monthly DROP employee salaries and employer contributions.
Fiscal year 7/1/17 - 6/30/18
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| Plan B Monthly Report 7/1/16-6/30/17
PDF Format |
To report monthly employee salaries, employee, and employer contributions.
|
| Plan B Monthly Report 7/1/17-6/30/18 |
To report monthly employee salaries and employee and employer contributions.
Fiscal Year 7/1/17 - 6/30/18
|
| Plan B Retirees Returning to Work Monthly Report 7/1/16-6/30/17 PDF Format |
| To report monthly retirees that have returned to work salaries, employee, and employer contributions. Fiscal Year 7/1/16-6/30/17
|
| Plan B Retirees Returning to Work Monthly Report 7/1/17-6/30/18 |
| To
report monthly retirees that have returned to work salaries, employee,
and employer contributions. Fiscal Year 7/1/17-6/30/18
|
| Refund Application - Mandatory Direct Deposit |
| Use this form for refunds of contributions. Effective March 1, 2014 all refunds must be direct deposit. No exceptions. If this form is not properly completed and signed, your refund will be delayed.
|
| Retire from Full-time Re-Employment |
| Use this form when a retiree that returned to full-time employment terminates. |
| Retiree RTW |
| Use this when you hire a MERS retiree for part-time or full-time employment. |
| Return to Work Earnings |
| This form is used to report monthly gross earnings for any employee that has retired from MERS and has returned to either full or part-time employment with your municipality. You should enter the gross monthly earnings, not the gross of their monthly pay checks. |
| Salary Evaluation |
| This must be attached to the member's retirement or DROP application. It is used to verify the highest consecutive or joined months of salary. |
| SSA-1945 |
| This form must be completed by all employees of municipalities that do not pay into social security. |
| Status Change Form |
| To be included with your monthly reports to have employees records updated with leave without pay, termination dates, disability dates, etc. |
| MISCELLANEOUS |
| |
| IRS Publication 575 |
| This publication will answer your federal income tax questions. |
