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For TIER III Plan Members check here For Hybrid Plan Members check here PLEASE TYPE OR PRINT Any alterations to this form will NOT be accepted RETIREMENT CREDIT PURCHASE REQUEST FOR PRIOR MISCELLANEOUS
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How to fill out for hybrid plan members?

01
Begin by gathering all necessary information and documentation. This may include your personal details, such as your name, address, and date of birth, as well as any identification numbers or membership information associated with your hybrid plan.
02
Review the instructions provided with the form to ensure you understand what information is required and how it should be provided. Pay attention to any specific sections or fields that may pertain to hybrid plan members.
03
Carefully fill out each section of the form, providing accurate and up-to-date information. Double-check your entries to avoid any errors or omissions that could potentially delay or affect the processing of your request.
04
If there are any sections or fields that you are unsure about or require additional information, reach out to your hybrid plan provider or employer for guidance. They will be able to assist you in completing the form accurately.

Who needs the form for hybrid plan members?

01
Hybrid plan members who are experiencing a life event that requires updates or changes to their plan information may need to fill out this form. Life events can include marriage, divorce, birth or adoption of a child, change of address, or any other circumstance that impacts your hybrid plan coverage.
02
Hybrid plan members who are enrolling in or making changes to their investment options within the plan will also need to fill out this form. It allows you to specify your investment choices and allocations based on your financial goals and risk tolerance.
03
Additionally, hybrid plan members who are leaving their current employment or retiring may need to complete this form to request a distribution or rollover of their hybrid plan funds. This ensures that the proper procedures are followed and that funds are transferred or distributed correctly according to relevant regulations and policies.
Remember to consult with your hybrid plan provider or employer if you have any specific questions or concerns regarding the form and its requirements. They will be able to provide you with the necessary guidance to ensure accurate and complete completion of the form.
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Hybrid plan members have a combination of defined benefit and defined contribution plans.
Employers sponsoring hybrid plans are required to file certain forms and reports.
Employers must fill out the necessary forms and reports accurately to report information about the hybrid plan members.
The purpose of filing for hybrid plan members is to ensure compliance with regulatory requirements and provide transparency to plan participants.
Information such as employee contributions, employer contributions, investment earnings, and plan distributions must be reported for hybrid plan members.
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