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CORRECTIONS OFFICER RETIREMENT PLAN 3010 E. Camelback Rd., Suite 200, Phoenix, Arizona 85016 (602) 255-5575 FAX (602) 296-2368 www.psprs.com FORM COST Page 1 of 2 09/13 OUT OF STATE SERVICE AFFIDAVIT
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Who needs form COSS - PSPRS?

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Employees: This form may be required for employees who need to make changes or updates to their personal information, employment details, or contributions to the COSS - PSPRS program.
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Employers: Employers may need to complete this form for new hires, terminations, or updates to their employees' information or contributions to the COSS - PSPRS program.
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Retirees: Retirees who receive benefits from the COSS - PSPRS program may need to periodically complete this form to provide updated information or make changes to their benefit options.
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Beneficiaries: In the event of a member's death, beneficiaries may need to complete this form to initiate or continue receiving benefits from the COSS - PSPRS program.
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Administrators: Those responsible for managing the COSS - PSPRS program may need to use this form for various administrative purposes, such as processing requests, updating records, or ensuring compliance with program regulations.
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Form COSS - PSPRS is a tax form used for reporting contributions to the Public Safety Personnel Retirement System (PSPRS) in Arizona.
Employers who have employees enrolled in the Public Safety Personnel Retirement System (PSPRS) are required to file Form COSS - PSPRS.
To fill out Form COSS - PSPRS, employers need to provide their identifying information, employee details, contribution amounts, and other required data as prompted on the form.
The purpose of Form COSS - PSPRS is to report contribution amounts to the PSPRS and ensure compliance with state retirement fund regulations.
Information required includes the employer's details, names and social security numbers of employees, contribution amounts, and any relevant dates.
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