Section 6 - IMRF

Illinois Municipal Retirement Fund Member Accounts / Past Service / Employer Resolutions / SECTION 6 

6 – Member Accounts/Past 

Service/Employer Resolutions 

MEMBER ACCOUNTS .............................................................................................................................................227 

6.00 INTRODUCTION ................................................................................................................................................. 227 

6.05 TO OPEN AN ACCOUNT - NEW OR REHIRED MEMBER ............................................................................................... 227 

6.10 ENROLLMENT DOCUMENTS ................................................................................................................................. 228 

6.10 A. Notice of Enrollment in IMRF (Online Enrollment or Paper Form 6.10, Exhibit 6N) .............................. 228 

6.10 B. Designation of Beneficiary (Form 6.11. Exhibit 6O) .............................................................................. 230 

6.10 C. Member Paid Irregularly ....................................................................................................................... 231 

6.10 D. Seasonally Employed Member .............................................................................................................. 232 

6.10 E. Election to Participate for Qualifying Position (Form 6.21, Exhibit 6R) ................................................. 232 

6.10 F. Election of Elected County Official to Participate in ECO ...................................................................... 233 

6.10 G. Election of Police Chief to Participate as a SLEP Member (Form 6.22, Exhibit 6T) ................................ 233 

6.10 H. Election to Contribute Under Additional Position (Form 6.23, Exhibit 6U) ........................................... 234 

6.20 TO UPDATE AN ACCOUNT.................................................................................................................................... 235 

6.20 A. Member Employment Information (Form 6.19, Exhibit 6P) .................................................................. 235 

6.20 B. Member Information Change (Form 6.20, Exhibit 6Q) ......................................................................... 235 

6.20 C. Election to Make/Change Voluntary Additional Contributions (Form 6.30, Exhibit 6X) ....................... 235 

6.20 D. Election to Cease Making IMRF Contributions (Form 6.24, Exhibit 6V) ................................................ 237 

6.20 E. Revocation of Election to Participate in Elected County Official Plan (Form 6.28, Exhibit 6W) ........... 238 

6.30 TO CLOSE AN ACCOUNT ...................................................................................................................................... 238 

6.40 PAST SERVICE CREDITS/MEMBER ACCOUNT CORRECTIONS ........................................................................................ 242 

Types of Past Service Credits ................................................................................................................................. 242 

6.40 1. Military Leave - “Application for Service Credit During Military Leave As Provided By The Illinois Pension 

Code” (Form 6.02J, Exhibit 6E)............................................................................................................... 245 

6.40 2. Military Leave - Application For Service Credit During Military Leave As Provided By The Uniformed 

Services Employment and Re-employment Rights Act (Form 6.02J, Exhibit 6E) ................................................... 248 

6.40 3. Reinstatement (Repay a refund) - “Application for Reinstatement of Service Credit”(Form 6.03, Exhibit 

6F) .......................................................................................................................................................... 249 

6.40 4. Retroactive - “Application for Retroactive Service Credit” (Form 6.04, Exhibit 6G) .............................. 249 

6.40 5. Omitted Service - “Omitted Service Credit Verification” (Form 6.05, Exhibit 6I) ................................... 250 

6.40 6. Prior Service - “Application For Prior Service Credit” (Form 6.07, Exhibit 6K) ....................................... 251 

6.40 7. Leave of Absence - “IMRF Benefit Protection Leave” (Form 6.32, Exhibit 6Y) ...................................... 251 

6.40 8. Out-of-State Service - “Out-of-State Service Credit Authorization” (Form 6.33, Exhibit 6Z) ................. 253 

6.40 9. Retroactive Service by General Assembly Members - “Application by Member of the General Assembly 

for Service Credit Authorization as Elected Official” (Form 6.34, Exhibit 6AA) ...................................... 253 

6.40 10. Certificate of Sheriff’s Law Enforcement Service (Form 6.71, Exhibit 6HH) ........................................... 253 

6.40 11. Conversion of Regular or SLEP Service Credit to Elected County Official (ECO) Service Credit (For 

earnings previously reported to IMRF) (Form 6.06, Exhibit 6J).............................................................. 254 

6.40 12. Conversion of Regular Service to SLEP Service (Form 6.09, Exhibit 6TT) ................................................ 254 

6.40 13. Transfer of Local Police Pension Fund Service into IMRF by Police Chief (Form 6.22, Exhibit 6T) ......... 254 

6.40 14. Transfers to State Employees’ Retirement System (Form 6.92, Exhibit 6WW) ...................................... 255 

6.40 A. General Requirements for Past Service Applications ............................................................................ 255 

6.40 B. Authorization ........................................................................................................................................ 256 

January 2014 Page 223

Member Accounts / Past Service / Employer Resolutions / SECTION 6 

Illinois Municipal Retirement Fund 

6.40 C. Member Application and Payments ...................................................................................................... 256 

6.40 D. Account Corrections Due to Court Order/Settlement of Litigation/Grievance Resolution .................... 258 

6.50 ANNUAL MEMBER’S STATEMENT OF ACCOUNT ....................................................................................................... 258 

6.50 A. Member’s Statement of Account (Exhibit 6A) ....................................................................................... 258 

6.50 B. Employer Report of Annual Member Statements (Exhibit 6B) .............................................................. 259 

6.60 DISCRETIONARY RESOLUTIONS (LOCAL POLICIES) ..................................................................................................... 259 

6.60 A. To Allow UNLIMITED Service Credit for Military Leave that INTERRUPTED IMRF Participation (Form 

6.62, Exhibit 6CC) .................................................................................................................................................. 259 

6.60 B. To Allow LIMITED Service Credit for Military Leave that INTERRUPTED IMRF Participation (Form 6.62A, 

Exhibit 6DD) .......................................................................................................................................................... 259 

6.60 C. To Allow Service Credit for Military Service PRIOR to IMRF Participation OR for Members Who Do Not 

Return to IMRF Participation within 90 Days (Form 63A, Exhibit 6EE) ................................................................. 260 

6.60 D. Relating to Participation by Elected Officials in IMRF (Form 6.64, Exhibit 6FF) .................................... 260 

6.60 E. Adoption of the 1,000 Hour Standard (Form 6.68, Exhibit 6GG) .......................................................... 260 

6.60 F. To Include Compensation Paid Under an Internal Revenue Code Section 125 Plan as IMRF Earnings 

(Form 6.72, Exhibit 6II) .......................................................................................................................................... 261 

6.60 G. To Include Compensation Directed into a Retirement Health Savings Plan (Form 6.73, Exhibit 6JJ) .... 261 

6.60 H. To Adopt IMRF Early Retirement Incentive (Form 6.77, Exhibit 6KK) .................................................... 261 

6.60 I. To Adopt Amortization Period for IMRF Early Retirement Incentive (Form 6.78, Exhibit 6LL) .............. 262 

6.60 J. To Authorize Pension Service Credit for Employees Previously Barred by Age (Form 6.79, Exhibit 6MM) 

............................................................................................................................................................. 262 

6.60 K. To Adopt Alternative Benefit Program for County Officers (ECO)......................................................... 262 

6.60 M. For Employer Pick-Up (Payment) of Member Contributions Required for Purchase of Extra Service 

Under the IMRF ERI (Form 6.85, Exhibit 6RR) ....................................................................................................... 262 

6.60 N. To Adopt the IMRF Sheriff’s Law Enforcement Personnel Program for Airport Police (Form 1.55, Exhibit 

6SS) ...................................................................................................................................................... 263 

6.60 O. To Include Taxable Expense Allowances as IMRF Earnings (Form 6.74, Exhibit 6XX) ....................... 263 

6.70 ACCOUNT ADJUSTMENT APPEAL RIGHTS ................................................................................................................ 264 

Page 224 January 2014


Sample Forms 

Exhibits 

6A ---- Personal Statement of Benefits 

6B ---- Employer Member Statement Expanded Summary report 

6C ---- Employer Member Statement Summary report - DISCONTINUED 

6D 6.01 Request for Rollover Approval for Past Service Credit 

6E 6.02J Application for Military Service Credit 

6F 6.03 Application for Reinstatement of Service Credit 

6G 6.04 Application for Retroactive Service Credit 

6H 6.04A Exhibit discontinued. 

6I 6.05 Omitted Service Credit Verification 

6J 6.06 Conversion of Regular or SLEP Service Credit to Elected County Official (ECO) 

Service Credit 

6K 6.07 Application For Prior Service Credit 

6M 6.08 Form discontinued. 

6N 6.10 Form discontinued. 

6O 6.11 Designation of Beneficiary 

6P 6.19 Member Employment Information 

6Q 6.20 Member Information Change 

6R 6.21 Election to Participate for Qualifying Position 

6T 6.22 Election of Police Chief to Participate as a SLEP Member 

6U 6.23 Election to Contribute Under Additional Position 

6V 6.24 40-Year Service Election to Cease Contributions 

6W 6.28 Revocation of Election to Participate in Elected County Official Plan 

6X 6.30 Election to Make/Change Voluntary Additional Contributions 

6Y 6.32 Leave of Absence - IMRF Benefit Protection Leave 

6Z 6.33 Out-of-State Service Credit Authorization 

6AA 6.34 Retroactive Service by General Assembly Members - Application by Member 

of the General Assembly for Service Credit Authorization as Elected Official 

6BB 6.41 Notice of Termination of IMRF Participation – Online termination only, no paper 

forms are accepted. 

6CC 6.62 Resolution: To Allow unlimited Service Credit for Military Leave that 

interrupted IMRF Participation 

6DD 6.62A Resolution: To Allow limited Service Credit for Military Leave that interrupted 

IMRF Participation 

6EE 63A Resolution: To Allow Service Credit for Military Service prior to IMRF 

Participation or for Members Who Do Not Return to IMRF Participation 

within 90 Days 

6FF 6.64 Resolution: Relating to Participation by Elected Officials in IMRF 

6GG 6.68 Resolution: Adoption of the 1,000 Hour Standard 

6HH 6.71 Certificate of Sheriff’s Law Enforcement Service 

6II 6.72 Resolution: To Include Compensation Paid Under an Internal Revenue Code 

Section 125 Plan as IMRF Earnings 

6JJ 6.73 Resolution: To Include Compensation Directed into a Retirement Health Savings 

Plan as IMRF Earnings 

6KK 6.77 Suggested Form of Resolution to Adopt IMRF Early Retirement Incentive 

6LL 6.78 Resolution: To Adopt Amortization Period for IMRF Early Retirement Incentive 

6MM 6.79 Exhibit discontinued. 

6NN 6.80 Exhibit discontinued. 

6OO 6.81 Resolution: To Allow More Than 50 Months of Retroactive Service Credit for 

County Board Members 

6PP 6.82 Resolution: To Revoke Alternative Benefit Program for County Officers 

6QQ 6.83 Exhibit discontinued. 




6RR 6.85 Resolution: For Employer Pick-Up (Payment) of Member Contributions Required 

for Purchase of Extra Service Under the IMRF ERI 

6SS 1.55 Suggested Form of Resolution to Adopt the IMRF Sheriff Law Enforcement 

Personnel Program for Airport Police 

6TT 6.09 Conversion of Regular Service Credit to SLEP Service Credit 

6WW 6.92 IMRF Transfer to State Employees Retirement System (SERS Alternative 

Retirement Formula Plan) Under Public Act 95-0530 

6XX 6.74 Suggested Resolution to Include Taxable Allowances as IMRF Earnings 

6YY 6.88 The Regional Office of Education as an IMRF Reporting Entity Distinct from the 

County IMRF. 

6ZZ VARF Request for Refund of Voluntary Additional Contributions (VAC) 

6AAA 1.56 Suggested Form of Resolution to Adopt the IMRF Sheriff Law Enforcement 

Personnel Program by Law Enforcement Officers of a Forest Preserve District 



Member Accounts 

6.00 Introduction 

This section explains the procedures and forms to be used to enroll, report, adjust, and terminate a member’s account. 

Help for Authorized Agents 

We’ve developed several resources to help you maintain member accounts: 

 

 

 

 

Sample completed forms, located at the end of this section, contain instructions on how to fill in and use 

forms correctly. 

Use the forms charts located in this manual to find the correct form quickly. 

Consult the IMRF-developed procedure check lists in the front of this manual when enrolling and terminating 

members. 

View member account information (participation date, years of service, wages and contributions, etc.) 

through the Employer Access area of IMRF’s web site. For details, refer to Paragraph 2.90 Secure Employer 

Access Area of www.imrf.org. 

6.05 To Open an Account - New or Rehired Member 

You should enroll an employee in IMRF as soon as he or she occupies an IMRF covered position (qualified position) 

(see Section 3). Failure to enroll an employee promptly with IMRF could eventually delay payment of benefits. 

After an employee is enrolled in IMRF, he or she becomes a member. Public Act 96-0889 created a second tier for 

IMRF’s Regular and Revised Elected County Official Plan. Effective January 1, 2011, IMRF will assign a benefit 

“tier” to an employee when he/she is enrolled in IMRF’s Regular or ECO plans. The plan tier is based on the 

member’s participation date: 

Tier 1: Members enrolled in any IMRF plan before January 1, 2011. If a Tier 1 member: 

Stops participating in IMRF and is again enrolled in IMRF, the member will participate in Tier 

1. 

Changes IMRF employers, the member will participate in Tier 1. 

 

Terminates participation, takes a refund of his or her contributions and is later enrolled in 

IMRF, the member will participate in Tier 1. Member is not required to pay back the refund. 

Tier 2: Members first enrolled in IMRF on or after January 1, 2011 

EXCEPTIONS: Members enrolled in IMRF on or after January 1, 2011, will participate in Tier 1 if 

the member: 

Previously participated in IMRF or in a reciprocal retirement system (except the Judges or 

General Assembly retirement systems) even if the member took a refund of his or her 

contributions and has not yet repaid the refund, 

or 

Purchases omitted service credit that creates a participation date before January 1, 2011. 

Once the member’s enrollment is confirmed, the member receives a “New Member Packet.” In this packet, the 

member receives a letter confirming his or her Social Security number, birth date, IMRF employer name, effective 

date of IMRF participation and IMRF plan tier. The member also receives an IMRF benefit booklet and other general 

information about IMRF. 




Service Credit Granted When Paid 

IMRF grants service credit for each month a member works, receives earnings, and makes the required IMRF 

contributions. There are exceptions to the “service credit only when paid” requirement, such as seasonal employees, 

elected officials, or employees paid irregularly. (See Paragraphs 6.10 C. Member Paid Irregularly and 6.10 D. 

Seasonally Employed Member.) 

6.10 Enrollment Documents 

6.10 A. Notice of Enrollment in IMRF (Online Enrollment or Paper Form 6.10, Exhibit 6N) 

Employers with Internet access must use Employer Access to enroll members. Employers without Internet access 

may continue to use IMRF Form 6.10. 

Do the following to ensure complete enrollment of a member in IMRF: refer to 

 

 

 

See the forms chart in the front of this manual. 

The enrollment procedure check list. 

Exhibit 5R, Return to Work and Effect on Tier 1 and Tier 2 Members Chart 

For a New or Rehired Employee 

Employers with Internet access must use Employer Access to enroll a new or rehired member. Employers without 

Internet access may continue to use IMRF Form 6.10 (see Exhibit 6N). 

If you are completing a paper Form 6.10, have each new or rehired employee whose position qualifies for IMRF 

coverage complete and sign the top half of the form. The Authorized Agent should complete and sign the lower 

half of the form. 

The form should be completed in triplicate: the first copy should be sent to IMRF, the second copy should be 

retained in the employee’s personnel file, and the third copy should be given to the employee. 

NOTE: Employers must determine if a new hire is a person receiving an IMRF pension from previous 

employment. Refer to paragraph 3.20D (600 hour employers) or 3.65D (1,000 hour employers). 

For an Employee Who is an Elected Official, Appointed to Elected Office, or a City Hospital 

Worker 

If an elected official or city hospital worker elects to participate in IMRF, IMRF requires the official’s or 

employee’s signature on the “Election To Participate For Qualifying Position” form. Therefore, as part of the 

online enrollment process, a pre-populated “Election To Participate For Qualifying Position” form is created. The 

employer will download the pre-populated form, sign it, have the elected official sign it and mail it to IMRF along 

with the signed enrollment form. 

The election to participate cannot be rescinded. An elected official who elects to participate in IMRF is required to 

continue to participate if re-elected to subsequent terms of office. 

The Elected County Official (ECO) Plan is closed to new members as of August 8, 2011. If a current elected 

county official has not elected to participate in ECO, he/she no longer has the option to do so. Future elected 

county officials may not elect ECO. If a county has not adopted the ECO plan, it no longer has the option to do so. 

Elected County Officials currently participating in ECO remain in the plan. 

For an Employee who is a Police Chief 

If the employee elects to participate in IMRF as a SLEP member, a pre-populated “Election of Police Chief to 

Participate as SLEP member” is created as part of the online enrollment process. The employer will download the 

pre-populated form, sign it, have the employee sign it and mail it to IMRF along with the signed enrollment form. 

(Please note: if the police chief is the first employee to enroll in SLEP for your employer, i.e., your employer does 



not have a SLEP plan, the online enrollment process will advise you to call IMRF’s Member Services Unit for 

assistance.) See paragraph 6.10 G. Election of Police Chief to Participate as a SLEP Member (Form 6.22, Exhibit 

6T). 

Refer to Paragraph 3.80C for information on eligibility requirements for police chiefs. 

For an Employee Who will Perform Teacher Aide Duties 

The Reciprocal Act allows a former IMRF member who participated as a teacher aide (paraeducator) and 

transferred to a position that is covered by the Teachers’ Retirement System (TRS) to retire under the Reciprocal 

Act even though the former teacher aide has less than 12 months of IMRF service credit. 

An employee who works as teacher aide may have a position title such as classroom aide, reading aide, teacher 

assistant, special services assistant/technician, program assistant, or library assistant. An employee is considered 

performing paraeducator duties if the employee will: 

Provide instructional support in the classroom for the teacher 

Tutor 

Supervise students in the cafeteria, playground, hallways or other areas of the school, or on busses or field 

trips. 

Work with Special Education students 

Work as a language assistant 

Supervise children in pre-K settings 

Procedures to Enroll New Employee Formerly Employed by Other IMRF Employer or 

Rehired by Same Former IMRF Employer 

1. Employers with Internet access must submit the employee’s enrollment via Employer Access. Employers 

without Internet access may continue to use paper Form 6.10, “Notice of Enrollment in IMRF.” 

2. IMRF requires that the member terminate (Employers with Internet access must terminate members via 

Employer Access, employers without Internet access may continue to use Form 6.41, “Termination of IMRF 

Participation,”) from the first employer and enroll (Form 6.10) with the second employer because in addition 

to keeping track of member credits, IMRF must also track employer liabilities. 

Without the appropriate termination and enrollment documents, IMRF is unable to maintain accurate member 

and employer accounts. However, some employees participate concurrently under two or more employers. If 

this is the case, IMRF only needs the Online Termination or paper Form 6.41 for the employer the member is 

terminating from. 




Do not submit an enrollment (via Employer Access or paper Form 6.10) for member 

personal information changes. 

Those changes should be made as follows: 

1. Changes to employment or IMRF coverage 

Use IMRF Form 6.19, “Member Employment Information.” (See Paragraph 6.20 A. 

Member Employment Information.) 

2. Changes to personal information, such as correction of Social Security number, birth 

date, etc.: 

Because online transactions are more accurate, more efficient, and faster than submitting 

member information to IMRF via paper forms, employers with Internet access must submit 

member information changes via Employer Access. 

3. Submit via Employer Access or paper Form 6.20 “Member Information Change.” (See 

Paragraph 6.10 B. Designation of Beneficiary (Form 6.11, Exhibit 6O)). 

6.10 B. Designation of Beneficiary (Form 6.11. Exhibit 6O) 

New IMRF members as well as active and inactive members wishing to change their beneficiaries should complete 

Form 6.11, “Designation of Beneficiary.” The designation becomes effective when the form is on file in IMRF’s 

office. 

IMRF recommends members designating a beneficiary online using their Member Access account. 

Online Enrollment process: IMRF mails beneficiary form to member 

After the employer enrolls a member online, IMRF mails a partially pre-populated Designation of Beneficiary form 

to the member’s home with a cover letter and self-addressed, postage-paid envelope. The letter confirms the 

member’s participation in IMRF and asks the member to complete and return the Designation of Beneficiary form. 

IMRF follows up with the member if the Designation of Beneficiary form is not returned. 

Guidelines for Members 

A member should update his or her beneficiary designation whenever a major life event occurs, such as a marriage, 

divorce, birth of a child or death of a previously named beneficiary. 

Members can view their beneficiary information via the Member Access area of IMRF’s website, www.imrf.org. 

IMRF can only accept the signature of the member to change a beneficiary. If someone other than the member 

submits a designation form, including an agent under a power of attorney, the form will not be accepted. 

Members who are Married or in a Civil Union 

Public Act 96-1140 changed the default beneficiary to the member’s estate. 

Previously, an active or inactive member’s spouse was the default beneficiary. Now, the member’s estate is the 

default beneficiary, regardless of the member’s marital status. The member’s spouse may not have the choice of a 

surviving spouse pension (assuming the spouse is eligible) unless the member has a designation of beneficiary form 

on file naming the spouse as his or her sole primary beneficiary. 

Previously, a retired member’s spouse was the default beneficiary for the $3,000 lump sum death benefit. Now, a 

retired member’s estate is the default beneficiary for the $3,000 lump sum death benefit. 

Naming a spouse as co-beneficiary 

A member who is married or in a civil union and not yet retired, can choose to name his or her spouse as co- 



beneficiary with other beneficiary(ies). As a co-beneficiary, the spouse would share in the lump sum death benefit. 

Under this arrangement, the spouse would not be eligible for a surviving spouse pension. 

Naming secondary beneficiaries 

Secondary beneficiaries receive the death benefit if no primary beneficiary survives. 

Single, Widowed or Divorced Members 

The default beneficiary is the member’s estate. A single, widowed or divorced member may choose to name 

children, parents, any other persons, a charity, or trust in lieu of the estate. 

Designation of Children 

A member may designate children by naming the specific children. 

Designation of Minor Children (under the age of 18) 

If a member names a minor(s) (individual under age 18) as a Primary Beneficiary(ies), death benefits will be paid 

in care of the minor’s guardian. 

If the member wants someone other than the guardian to receive the IMRF benefit on behalf of the minor, the 

member may name a custodian, who is 21 years of age or older, under the Illinois Uniform Transfers to Minors 

Act. This is done by entering the name of the individual the member wishes to appoint as custodian followed by “as 

custodian for____________ (name of minor) under the IUTMA.” 

Change in Beneficiary 

The member may change his or her beneficiary(ies) by filing a new Form 6.11, “Designation of Beneficiary.” 

IMRF recommends members use their online Member Access account to make beneficiary updates. 

A member should update his or her beneficiary designation whenever a major life event occurs, such as a marriage, 

divorce, birth of a child or death of a previously named beneficiary. 

NOTE: In the event that no Form 6.11, “Designation of Beneficiary,” is filed for a member, the member’s estate 

will be the beneficiary. 

6.10 C. Member Paid Irregularly 

Members paid irregularly include those elected officials who are in office and work each month during the year, 

but are not paid each month. These officials must: 

 

 

Hold positions qualified for IMRF coverage (see paragraph 3.65 Participating Members), and 

Have filed all necessary enrollment documents with IMRF (see paragraph 6.10 A. Notice of Enrollment in 

IMRF (Online Enrollment or paper Form 6.10, Exhibit 6N)). 

Members paid irregularly also include employees who perform services for the employer but are not paid each 

month they work because as a condition of employment they are paid bi-monthly (every other month), quarterly, 

semi-annually, or annually. In other words, an irregularly paid member is one who does not hold a seasonal 

position, but works every month and is paid less often than monthly. 

Those members will earn service credit for their unpaid months provided the member is paid at least once during 

the year, that is, provided the employer reports wages and contributions for the member at least once during the 

year. Both the paid and unpaid months will be credited to the member’s account. In other words, the member will 

receive 12 months of service credit for the year. 

To indicate that the member will be paid irregularly, check “yes” for the paid irregularly question on the Online 

Enrollment screen or on Form 6.10, “Notice of Enrollment.” 

If we need additional information regarding the irregular pay periods, we will contact the employer. 




6.10 D. Seasonally Employed Member 

A seasonal member is one whose position requires regular service for a period of at least six consecutive months 

but less than 12 months in a 12-month period. This does not refer to a calendar 12 months of January through 

December, but to any 12-month period. 

“Seasonal” members hold positions that normally require less than 12 months of work during a 12-month period. 

Examples: a school district employee whose position normally requires him or her to work September through 

June, with July and August off. Or, a park district employee whose position normally requires him or her to work 

March through November, with December through February off. In seasonal positions, work is generally not 

required during specific months or periods of the year. 

A seasonal member in an employment relationship for 12 months will receive service credit for the entire 12-month 

period. Otherwise, the member will receive service credit for the number of months actually worked in which a 

contribution was made. In other words, if a member is employed by the unit of government for 12 months (even if 

he or she is on “seasonal leave”), the member will receive 12 months of service credit. 

To indicate that the member will be seasonally employed, check “yes” for the seasonal position question on the 

Online Enrollment screen or on paper Form 6.10, “Notice of Enrollment.” 

Seasonal employees will automatically receive seasonal service credit based upon the member’s “seasonal pattern.” 

The seasonal pattern is determined by the type of employer: 

School Districts, Educational Districts, and Educational Regions: 

Seasonal employees will receive seasonal service credit for June, July, August, and September. (Employer can 

designate a different seasonal pattern.) 

Park Districts and Forest Preserve Districts: 

Seasonal employees will receive seasonal service credit for October, November, December, January, February, 

and March. (Employer can designate a different seasonal pattern.) 

All other employers who have seasonal employees: 

IMRF will contact the employer to determine the appropriate seasonal patterns. (Employer can designate a 

different seasonal pattern.) 

Once a seasonal pattern is determined, the member will automatically receive seasonal service credit for the 

seasonal months unless: 

Wages/service have not been reported for the non-seasonal period. 

A Notice of Termination (Online Termination or paper Form 6.41) has been submitted for the member. 

The member is on an IMRF Benefit Protection Leave (member receives Benefit Protection Leave service). 

The member is receiving IMRF disability benefits (member receives disability service credit). 

For an employee to receive this seasonal service credit automatically, he or she must be identified as seasonal on 

the Notice of Enrollment. 

6.10 E. Election to Participate for Qualifying Position (Form 6.21, Exhibit 6R) 

Only elected officials and city hospital employees have the option to participate in IMRF if their positions qualify 

them for membership. 



Elected officials may exercise the option to participate only if the governing body has filed a resolution (Form 6.64, 

“Resolution - Elected Officials,” Exhibit 6FF) finding their position qualifies for IMRF coverage (see paragraph 

3.65 Participating Members). 

IMRF may be contacted to determine if a resolution has previously been submitted. Employer resolutions can also 

be viewed via Employer Access. 

If an elected official or city hospital employee elects to participate in IMRF, IMRF requires the official’s or 

employee’s signature on the “Election To Participate For Qualifying Position” form. As part of the online 

enrollment process, a pre-populated “Election To Participate For Qualifying Position” form is created. The 

employer will download the pre-populated form, sign it, have the elected official or city hospital employee sign it 

and mail it to IMRF along with the signed, pre-populated enrollment form. 

Elected officials and hospital employees who wish to participate must complete Form 6.21, “Election to 

Participate, Exhibit 6R,” at the time of enrollment. It should be submitted after the employer completes the Online 

Enrollment process or with Form 6.10, “Notice of Enrollment in IMRF.” 

If an elected official elects to participate 

If an elected official elects to participate, the elected official cannot revoke that choice as long as he or she holds 

the same elective position within that governmental unit. 

If employment is terminated and he or she later holds the same elected position with the same employer, the elected 

official will again participate in IMRF. The elected official cannot revoke his or her prior election to participate in 

IMRF. 

For example: Mary Jones is elected to city clerk and she chooses to participate in IMRF as city clerk. However, 

Mary loses her bid for reelection. Several years later Mary again runs for city clerk and this time she wins. Now, 

because she chose to participate as city clerk previously, Mary must participate in IMRF now. 

If Mary had run for a different elected position, county auditor, for example and won, she could have chosen not to 

participate because she had never chosen to participate under the county auditor position. 

The same rules apply whether an elected official loses a bid for reelection or resigns. Once an elected official 

chooses to participate, the elected official must participate as long as he or she holds that same position. 

NOTE: a special temporary provision did permit elected officials to permanently revoke an election to participate 

from September 8, 1991, through December 31, 1991. 

If a city hospital worker elects to participate 

If a city hospital worker elects to participate, he or she cannot revoke that election as long as the member is 

employed by the city hospital. 

If the member terminates and later returns to employment with the same city hospital, the city hospital employee 

cannot revoke his or her prior election to participate. 

6.10 F. Election of Elected County Official to Participate in ECO 

The ECO Plan is closed to new members as of August 8, 2011. 

6.10 G. Election of Police Chief to Participate as a SLEP Member (Form 6.22, Exhibit 6T) 

Appointed police chiefs of cities, towns and villages that have formed their own police pension fund under Article 

3 of the Illinois Pension Code have the option to participate in either the local police pension fund or in IMRF 

SLEP. Participation under IMRF’s Regular plan is not an option for these police chiefs. A chief of police who 

elects to participate in IMRF as a SLEP member must complete Form 6.22, “Election of Police Chief to Participate 

as a SLEP Member,” (Exhibit 6T). 




A pre-populated Form 6.22 is created as part of the online enrollment process. The employer will download the 

pre-populated form, sign it, have the employee sign it and mail it to IMRF along with the signed enrollment form. 

(Please note: if the police chief is the first employee to enroll in SLEP for your employer, i.e., that your employer 

does not have a SLEP plan, the online enrollment process will advise you to call IMRF’s Member Services for 

assistance.) 

Refer to Paragraph 3.80 for information on eligibility requirements for police chiefs. 

Newly appointed police chiefs have 90 days from the date of hire to elect to participate in either the local police 

fund or in IMRF SLEP. Failure to submit an election to either the local police fund or IMRF SLEP within those 90 

days forfeits the police chief’s right to participate in either. 

If the Police Chief chooses to join IMRF SLEP: 

Once the police chief elects to participate in IMRF’s SLEP program, that election cannot be revoked. 

Therefore, should a chief elect to participate in IMRF SLEP under employer A, upon changing positions 

to a patrolman under employer A, or even a patrolman under employer B, the chief must continue to 

participate under IMRF’s SLEP plan. 

Before hiring a police chief, the employer may want to know if the police chief has any local police 

pension plan service eligible for transfer into IMRF. After electing to join IMRF’s SLEP program, the 

police chief may transfer police service previously established in any Illinois police pension fund to 

IMRF. See Paragraph 630.13. 

 

The chief may also wish to get an estimate of the cost to transfer any local police pension past service to 

IMRF before making the choice of IMRF SLEP. IMRF recommends the police chief review and 

evaluate the benefits of the local police pension fund and the SLEP Plan to determine which plan is most 

advantageous. 

If the Police Chief chooses to join the police pension fund: 

If the police chief chooses to join the police pension fund, the police chief can decide to join IMRF’s 

SLEP program at a later date if he is still a police chief for a qualifying IMRF SLEP employer. 

If the Police Chief chooses to join neither SLEP nor the police pension fund: 

If the police chief chooses not to join the IMRF SLEP program nor the police pension fund, the police 

chief will not be able to join the IMRF SLEP program at a later date as a police chief. 

6.10 H. Election to Contribute Under Additional Position (Form 6.23, Exhibit 6U) 

Form 6.23, “Election to Contribute Under Additional Position” should be used for a member who currently 

participates in IMRF and wants to make member contributions in an elected position which does not qualify for 

participation in and of itself. 

Use this form for an IMRF member who currently works in a qualifying position, who also holds a nonqualifying 

elective office with the same employer, and who wants to make member contributions under the additional 

position. 

If the member’s second position is a non-qualifying elective office position and that position becomes qualifying at 

a later date, the member cannot revoke this election to participate under that elected position. 



6.20 To Update an Account 

6.20 A. Member Employment Information (Form 6.19, Exhibit 6P) 

Employers must provide missing or corrected information regarding a member’s employment information through 

Employer Access. 

Employers would also submit information regarding a member’s position(s), such as a change of plan (plan refers 

to Regular, SLEP or ECO) through Employer Access. 

Some examples of these changes are: 

 

 

 

 

 

 

When a member’s position changes from Regular qualified to SLEP qualified. 

To add a plan for a member who currently participates in the Regular plan and begins working in a SLEP 

qualified position. 

To add a plan for a member who currently participates in SLEP and begins working in a Regular qualified 

position. 

To delete a plan for a member who held qualifying positions under both plans but will now hold one position 

only. 

To change a member’s participation date. 

To change a member’s employment date. 

6.20 B. Member Information Change (Form 6.20, Exhibit 6Q) 

Employers with Internet access must submit member information changes via Employer Access. For details, refer 

to Paragraph 2.90 Secure Employer Access Area of www.imrf.org 

If your employer does not have Internet access, complete Form 6.20, “Member Information Change.” This form 

should be used for identification changes only, such as changes in name, address, birth date, sex, and Social 

Security number. Do not use this form for enrollment. 

6.20 C. Election to Make/Change Voluntary Additional Contributions (Form 6.30, Exhibit 6X) 

IMRF members have the option of making after-tax voluntary additional contributions to provide a supplemental 

retirement benefit in addition to the usual IMRF retirement pension. At retirement, the voluntary additional 

contributions may be taken as a lump sum or, provided the member’s account balance is $4500 or more, as an 

additional monthly pension. 

These after-tax voluntary additional contributions are limited to 10% of IMRF reportable earnings and are not 

matched by the employer. The additional retirement benefit is based solely upon the accumulated voluntary 

contributions plus interest. 

Voluntary additional contributions are after tax—they are not tax-deferred like usual IMRF member contributions. 

Some members may be better served by contributing a portion of their salary on a pre-tax (tax-deferred) basis to 

their employer’s deferred compensation plan, e.g., 457 or 403(b). 

The rate of interest paid is currently 7-1/2%. This interest rate can change at any time in the future. The procedures 

for crediting interest are established by state law. Voluntary additional contributions interest is credited differently 

from a traditional savings account. A traditional savings account credits interest on the current amount in the 

account. 

IMRF credits interest at the end of the year on the beginning of the year balance. Therefore, a member will not 

earn any interest the first year he or she begins making voluntary additional contributions. If a member begins 

making voluntary additional contributions in June 2011, the interest would not be credited until December 2012. 




The following chart illustrates how interest is credited to voluntary additional contributions. 

(Assumes 7.50% interest rate does not change) 

January 1, 2014 opening balance $0.00 

VA Contributions made during 2014 $400.00 

Interest credited on December 31, 2014 based upon January 1, 2014 

opening balance $0 x 7.50% $0.00 

January 1, 2015 opening balance $400.00 

VA Contributions made during 2015 $500.00 


opening balance $400.00 x 7.50% $30.00 

January 1, 2016 opening balance 930.00 

VA contributions made during 2016 $500.00 


opening balance $930 x 7.50% $69.75 

Members wishing to make voluntary contributions must file Form 6.30 (Exhibit 6X), “Election to Make Voluntary 

Additional Contributions.” 

Members wishing to change the amount withheld or stop making voluntary additional contributions would also 

complete Form 6.30. A participating member may stop making voluntary additional contributions at any time. 

Members wishing to request a refund of their VA contributions must file a Form VARF, "Request for Refund of 

Voluntary Additional Contributions" (Exhibit 6ZZ). 

Deductions can begin immediately once the employer completes the application and submits it to IMRF. 

Voluntary additional contributions cannot be treated as a 414(h) tax deferral. The contributions must be included in 

the taxable income reported to federal and state tax authorities. 

NOTE: Voluntary additional contributions are made with after-tax dollars. Therefore, the contributions are not 

subject to federal income tax when the member withdraws them. However, that portion of the refund attributable to 

the tax-deferred interest is subject to 20% withholding for federal income tax. If the member is under age 59-1/2, a 

penalty tax of 10% may also apply. 

The withholding and penalty tax can be avoided if the tax-deferred interest is directly rolled over into a traditional 

IRA, Roth IRA, or other qualified plan, or 457 or 403(b) plan. 

Refunds of Voluntary Additional Contributions 

IMRF’s Voluntary Additional Contribution plan is designed for long-term savings, i.e., additional retirement 

income or survivor benefit. Also, although members can apply for a refund of their voluntary additional 

contributions at any time, IMRF discourages such refunds. If a member is seeking a short-term savings vehicle, 

voluntary additional contributions may not be the right choice. However, if a financial hardship exists, the 

member can apply for a refund of his or her Voluntary Additional Contributions by submitting a request in writing. 

Partial refunds are not allowed. 



 

If the member will continue working for his or her IMRF employer 

A member may take a refund of Voluntary Additional Contributions without interest while he or she is still 

working for an IMRF employer. The interest must stay on deposit until the member stops working for his or 

her IMRF employer. 

The interest will continue to earn interest until the member stops working for his or her IMRF employer and 

applies for a refund of the interest. 

 

If the member stops working for his or her IMRF employer and applies for a refund of Voluntary Additional 

Contributions 

A member may take a refund of Voluntary Additional Contributions with interest if he or she is no longer for 

an IMRF employer. 

If the member is less than age 59-1/2, the taxable portion of the refund (the interest earned) will be subject to 

income tax penalties. The member can avoid these income tax penalties by rolling over the taxable portion 

into an IRA or other qualified retirement plan. Unless the taxable portion is directly rolled over, federal law 

requires IMRF to make a 20% tax withholding. 

 

If the member stops working for his or her IMRF employer and applies for a refund of usual IMRF member 

contributions (a “separation refund) 

The Voluntary Additional Contributions with interest must be refunded at the same time. 

If the member is less than age 59-1/2 when he or she applies for a separation refund, the taxable portion of the 

refund (interest) will be subject to income tax penalties. The member can avoid these income tax penalties by 

rolling over the taxable portion into an IRA or other qualified retirement plan. Unless the taxable portion is 

directly rolled over, federal law requires IMRF to make a 20% tax withholding. 

Upon termination of participation, if the member applies for a separation refund, the accumulated voluntary 

additional contributions with interest must also be withdrawn. If the usual IMRF contributions are left on deposit, 

the member has the option of leaving the voluntary additional contributions on deposit or withdrawing them. 

Upon retirement, the voluntary additional contributions and interest may be applied to a monthly annuity payable 

for life, provided the member’s account balance is $4500 or more, OR withdrawn in a lump sum. 

Upon death, the accumulated voluntary additional contributions with interest are payable to the member’s 

beneficiary(ies). 

6.20 D. Election to Cease Making IMRF Contributions (Form 6.24, Exhibit 6V) 

A member who currently participates in IMRF and has 40 or more years of service credit can elect to stop making 

IMRF contributions. Use Form 6.24, “40-Year Service Election to Cease Contributions,” to stop member and 

employer retirement contributions for the member. 

A member with 40 years of IMRF service credit is allowed this option because the maximum IMRF pension 

payable is 75% of a member’s final rate of earnings (FRE). That 75% is earned after 40 years. 

If a member chooses to stop making contributions to IMRF, he or she will receive the 4-1/2% of salary that would 

have been contributed to IMRF (less federal and state income taxes). The member’s FRE will be frozen as of the 

effective date of the election. 

The member will continue to be treated as a participating member for the purposes of death and disability benefits. 

That is, the member will remain eligible for IMRF death and disability benefits (assuming all other benefit 

eligibility requirements are met.) 




The member would not be eligible for an IMRF retirement benefit until he or she stops working in an IMRF 

qualified position and applies for a retirement annuity. 

6.20 E. Revocation of Election to Participate in Elected County Official Plan (Form 6.28, 

Exhibit 6W) 

A member who elected to participate in either Original or Revised ECO can revoke that election by completing 

IMRF Form 6.28, “Revocation of Election to Participate in Elected County Official Plan.” 

The member will freeze his or her ECO final rate of earnings and continue to participate in Regular IMRF or SLEP 

(as appropriate). If the member chooses to stop participating in the ECO plan, the decision is irrevocable. He or she 

may not re-enroll in ECO at a later date. The member will then participate in the Regular or SLEP plan, as 

appropriate. 

1. If the member joined ECO before January 26, 2000 (Original ECO) 

The revocation is effective on the last day of the month, e.g., if the form is signed on March 2 nd , the 

revocation is effective on March 31 st . 

After filing the form, the employer should deduct the appropriate member IMRF contributions (Regular or 

SLEP) from the member’s payroll earnings beginning with next month’s Monthly Deposit Report (e.g., if 

Form 6.28 is dated March, deduct Regular or SLEP contributions starting in April). 

2. If the member joined ECO on or after January 26, 2000 (Revised ECO, Tiers 1 and 2) 

The revocation is effective on the date the form is signed. 

The employer would deduct the appropriate member IMRF contributions (Regular or SLEP) from the 

member’s payroll earnings beginning with the next payroll. 

Because the member’s IMRF contribution changes with the next payroll, the employer may need to report the 

member’s wages and contributions under two plans (Regular or SLEP and ECO) for the next month’s 

Monthly Deposit Report. 

Wages paid before Form 6.28 was signed will be reported under ECO; wages paid after Form 6.28 was 

signed will be reported under Regular or SLEP. 

6.30 To Close an Account 

IMRF developed a procedure check list to assist Authorized Agents with the termination process. Refer to the forms 

chart in the front of this manual. 

When terminating a member’s IMRF participation: 

 

 

Use the Termination Procedure Check List on the IMRF website, www.imrf.org. 

Employers with Internet access must submit a member’s termination of participation through the Employer 

Access area of the IMRF website. Employers without Internet access may continue to submit paper Form 

6.41, “Termination of IMRF Participation.” 

A termination of participation must be submitted for members who change participation status or who terminate 

employment. The employer identifies the reason for the termination as follows: 

 

Reasons if employment continues but participation status changes. 

Change from an IMRF-covered position to a non-qualifying (Social Security only) position, or 

Move from an IMRF-covered position to a position covered by another Illinois public pension system, or 

Retire while working reduced hours (Member applied for an IMRF pension but will continue working in a 

non-qualifying position.) 



 

Reasons if employment ends: 

Retirement 

Resignation 

Member voluntarily resigned the position for other than medical reasons, e.g., accepted a position 

elsewhere, resigned for personal reasons. 

Resignation medical 

Member voluntarily resigned the position for health/medical reasons. (Member voluntarily resigned 

because he/she is unable to perform the duties of the position because of a medical condition; member is 

unable to continue working or return to work. A member’s voluntary resignation must be documented by 

a resignation letter from the member to the employer, or by a letter from the employer to the member 

acknowledging the voluntary resignation. If the member is receiving IMRF disability benefits or has a 

pending claim for disability benefits, he/she will no longer be eligible for IMRF disability benefits. 

Exceptions apply if the member has filed a Workers’ Compensation claim. Refer to Paragraph 5.40 D.5.) 

Dismissal 

The employer is terminating the member’s employment for reasons other than a medical condition, e.g., 

work performance issues, budget cuts. 

Dismissal medical 

The employer is terminating the member’s employment for health/medical reasons. (A medical condition 

prevents the member from performing the duties of his/her position; the member is unable to continue 

working or return to work. If the member is receiving IMRF disability benefits or has a pending claim for 

disability benefits, he/she remains eligible for IMRF disability benefits.) 

Death 

Military leave 

Term expired (elected officials only) 

1. Determining the last day of IMRF participation 

When terminating a member’s IMRF participation the date entered as “Last Day of IMRF Participation” 

should be the last day the employer considers the member to be an employee. 

This is an important date and can impact a member’s benefits. For example, if a member is terminating for 

retirement and the last day of participation is entered as March 15, the member’s pension will be effective 

April 1. 

However, if the employer will pay the member sick and vacation time until May 12 and the employer 

indicates the termination date is May 12, the pension would not be effective, and therefore payable, until 

June 1. 

Therefore, when an employer terminates a member’s participation because the member is retiring, the 

employer should tell the member what his or her IMRF termination date is. That way, the member will know 

when to expect the first pension check. 

IMRF calculates a member’s benefit effective date based upon the last day of participation provided by the 

employer. The employer determines a member’s last day of IMRF participation. 

2. Terminating members in the Elected County Officials (ECO) Plan 

a. Stipends 

Many elected officials receive stipends paid by the State of Illinois. Stipends are IMRF earnings for all 

benefit calculation purposes if they are paid to the member while he or she is in an IMRF qualifying 

position or within one month of the month in which he or she terminates IMRF participation. 




IMRF member contributions are to be deducted from the payment and remitted to IMRF. In addition, 

counties are required to make employer contributions on the gross amount. The ECO employer 

contribution rate is applied to stipends for those officials enrolled in the ECO plan. 

Generally stipends are paid once a year and cover 12 months of elected service. There is an exception 

if the official ceases to hold office. In that case, the stipend is prorated and payment is made for each 

month the official held office since his or her last stipend payment. 

Stipends are an annual payment and if not previously reported should be reported as such when 

terminating an ECO plan member’s participation.. The total amount reported for the final earnings 

should never exceed the annual salary plus one annual stipend amount. In other words, if during one 

calendar year an official receives both the usual 12-month stipend payment plus a second stipend 

payment for a partial year to reflect the last portion of his or her term in office, you would report only 

the 12-month amount. 

Example 1 

An official makes $40,000 per year and receives an annual stipend of $3,600. The stipend is paid every 

July for the previous July 1 through June 30 period. The official resigns on September 30. When 

completing the termination, you would report at an annual salary of $40,000 and an annual stipend of 

$3,600. Do not report a stipend of $4,500 ($3,600 plus $900 for 3 months at $300 per month). 

Example 2 

An official makes $44,500 per year with an annual stipend of $3,600 paid in July. However, beginning 

July 1, the annual stipend was increased to $5,000. The official leaves office on December 2. At the 

time he left office he has yet to receive his prorated stipend for the July through November period (in 

fact, payment is not received until the following February). When completing the termination, you 

would report an annual salary of $44,500 and an annual stipend of $5,000. This is because the statute 

requires IMRF to use the salary in effect on the date of termination ($44,500 and $5,000). 

b. Per Diem earnings 

Some County Board members receive a payment for each County Board or Committee meeting 

attended. Unlike salaried officials, you cannot merely rely on the salary schedule in effect on the date 

of termination. The per diem payments vary widely from month to month. When completing the final 

earnings and contributions report, include as final annual salary the total per diems paid to the official 

within the last 12 months of his or her service. 

Example 3 

The County pays per meeting attended. The Board member leaves office on December 2 (without 

attending any meetings that month). During the last 12 months of the term, the board member attended 

one meeting in December of last year, no meeting in January, three meetings per month for nine 

months, and six meetings in the last month for a total of 34 meetings. He or she was paid $3,400 

during the 12-month period. Enter $3,400 as the final annual salary earned. 

Example 4 

Same facts as in Example 5, except the official turns in all his or her per diem requests in November, 

the month before leaving office. His or her final annual salary earned is $3,400. It is not $3,400 times 

12 months or $40,800. 

c. Expense Reimbursements (Mileage, Meals) 

Expense reimbursements are not IMRF earnings and should not be added to an official’s salary or per 

diem. They should not be reported to IMRF as part of the official’s final annual salary. 

d. Premium Pay 

Many Counties pay Board members an additional amount to participate on committees, to be 

committee chairpersons or to be Board President. Some Board Presidents receive an additional 

payment to be liquor commissioner. This premium pay is considered IMRF earnings and should be 

reported to IMRF. 



Example 5 

A County Board member is paid $100 per meeting and $500 extra to be a committee chairperson. In 

his last 12 months of office, he attended 53 meetings. You should report his final annual salary as 

$5,800 (53 times $100 plus $500). 

Example 6 

A County Board President is paid $6,000 per year as salary. Your Board President decides to also act 

as liquor commissioner and is paid an additional $1,200. You should report his final annual salary as 

$7,200. 

e. Vacation, Sick Leave, Personal Leave, etc. 

Normally, elected officials do not earn and are not paid for unused vacation, sick leave, personal leave 

or other such forms of paid leave. However, an occasion may arise that a non-elected employee 

becomes an elected official, and the County permits them to carry over any unpaid leave to their 

elected position. 

Upon termination of office, the official may be eligible for payment of such unpaid leave earned in the 

former non-elected position. If the monies are paid before termination or the first month after 

termination, the monies are reportable earnings and employee contributions are deductible. 

However, those payments may not be reported for a terminating ECO member as either the member’s 

final annual salary or the member’s stipend. These payments are neither salary nor stipends as those 

terms apply when determining an elected official’s retirement benefit. 

f. Determining an Original ECO plan member’s final earnings 

If a county has officials participating in the Original Elected County Official (ECO) plan (official 

joined ECO prior to January 26, 2000), reporting an original ECO member’s final earnings can be 

complicated. When calculating an original ECO retirement benefit, IMRF must use the official’s salary 

at the termination of service. 

There is no requirement that the final salary be in effect for any stated period of time. The number of 

payments or their amount in the official’s last month or year becomes irrelevant. What is crucial is the 

annual salary rate at which the official was paid on his or her last day of office. NOTE: The member 

must have worked in the position for at least 600 or 1,000 hours (as applicable) in order for the salary 

of that position to be used as the final earnings. 

Example 7 

At the beginning of the official’s term, the salary is set at $40,000 with 3% increases authorized for the 

second, third, and fourth years ($40,000; $41,200; $42,436; and $43,709). The term begins on 

December 1 and the salary increases occur annually each December 1 st thereafter. 

If the official completes his or her term and retires, the ECO retirement benefit will be calculated using 

a final salary of $43,709. The $43,709 is the salary in effect at the time of retirement. It is an annual 

number. 

Example 8 

Facts are the same as in the previous example except the official resigns and leaves office on 

December 3 of his or her fourth year in office. The official will have been in office for 3 days during 

the $43,709 salary schedule. Although the official has not held office for the entire fourth year, the 

salary in effect at the time of retirement is $43,709. The ECO retirement benefit will be calculated 

using that amount as the final salary. 

g. Determining a Revised ECO plan member’s final earnings 

If a county has officials participating in the Revised Elected County Official (ECO) Plan (official 

joined ECO on or after January 26, 2000), the Revised ECO member’s final rate of earnings (FRE) is 

calculated in the same manner as the Regular Plan FRE. However, a separate FRE is calculated for 

each elected county position the member held in the same county. The ECO monthly FRE does not 

include any lump sum payments for vacation, sick leave, overtime, personal leave, etc. 




3. Members changing pension systems 

A termination of IMRF participation must be submitted when members are required to participate in another 

Illinois public pension system. For example: school employees who change positions to become teachers 

must change from IMRF to the State Teachers’ Retirement System. 

If a member continues to be employed by the same employer, the member is not eligible for a separation 

refund. 

However, if the member has participated in IMRF for 12 or more months (or believes he or she will return to 

IMRF participation to attain 12 or more months of service credit), his or her contributions can be used in the 

calculation of a reciprocal pension. The member will fall under the rules of the Illinois Retirement Systems’ 

Reciprocal Act (see paragraph 5.50 Reciprocity ). 

4. Members changing IMRF employers 

A termination of IMRF participation must be submitted for members leaving the employment of one IMRF 

employer to work for another IMRF employer. 

These members are not entitled to a refund of their IMRF member contributions. However, if a gap exists 

between the termination date for the first employer and the enrollment date for the second employer, the 

member may be eligible for a refund. 

IMRF requires that the member terminate from the first employer and enroll with the second employer. This 

information is required because in addition to recording a member’s contributions and service, IMRF also 

records an employer’s liabilities for its members. 

Without the appropriate termination and enrollment information, IMRF would be unable to maintain accurate 

member and employer accounts. 

If a member participating in Tier 1 terminates from one IMRF employer and enrolls with a second employer, 

that member will continue to participate in Tier 1. See Paragraph 6.05, To Open an Account. 

5. Service credits with multiple employers combined 

If a member terminates employment with one IMRF employer and continues participation (or at a later date 

participates) through another IMRF employer, no action is needed to combine the member’s account. Service 

credits with multiple IMRF employers will be considered together in computing a pension or other benefit. 

For further explanation of IMRF benefit rights relevant to the above terminations, see Section 5. 

6.40 Past Service Credits/Member Account Corrections 

Types of Past Service Credits 

Summary Chart: types, eligibility, forms, employer action 

All past service types are explained in this Section. This table provides a summary of the most common types of past 

service. Note: a person must be an active IMRF participant to apply for past service credits. For certain types of past 

service, a person is also eligible to apply if an active reciprocal system participant. 



Member’s Situation 

Member took a refund of his or her IMRF 

contributions in the past. Now member 

wants to pay back the refund and 

reinstate the service credit. 

Member’s position qualified for IMRF, 

but the employer did not enroll the 

member in IMRF. 

Member wishes to convert time served in 

the U.S. Military to IMRF service: 

Under Federal Law: 

Military leave interrupted IMRF 

participation and the member returned to 

the same IMRF employer. 

Under Illinois Law: 

 

OR 

 

Military leave interrupted IMRF 

participation and member returned 

to any IMRF employer within 90 

days of discharge. 

Military leave earned before 

member joined IMRF OR member 

did not return to any IMRF 

employer within 90 days of 

discharge. 

Member was working for his or her 

employer when it joined IMRF. Member 

was granted the maximum free service 

(20% of service up to five years) and 

wishes to purchase remaining service. 

Member is an elected official who held 

an office qualifying for IMRF. Member 

now participates in IMRF and wishes to 

purchase up to 50 months of previous 

elected official service. 

Member is an elected official who held 

an office qualifying for IMRF. He or she 

now participates in IMRF and wishes to 

purchase more than 50 months of 

previous elected official service credit. 

Type of Service 

IMRF Form to Complete 

Reinstated Service 

Form 6.03 Member can also 

submit Form 6.03 via 

Member Access 

Omitted Service 

Form 6.05 

Military Service 

Under Federal Law 

Under Illinois Law 

Form 6.02J 

Prior Service 

Form 6.07 

Retroactive Service 

Form 6.04 

Retroactive Service 

Form 6.04 

None 

Action the Employer Takes 

Verifies member’s position 

qualified for IMRF. 

Then certify member’s wages and 

omitted months of service on 

IMRF Form 6.05 

Under Federal Law: 

None 

Under Illinois Law: 

 

Governing body must choose to 

pass a resolution authorizing the 

leave, 

AND 

Complete IMRF Form 6.62, 

Military Leave Authorization, or 

 

IMRF Form 6.62A, Limited 

Military Leave Authorization, 

OR 

Complete IMRF Form 63A, 

Military Leave Authorization for 

Military Service Prior to IMRF 

Participation. 

Certify member’s wages and months of 

qualifying service on Form 6.07, 

Application for Prior Service Credit. 


approve and file a resolution finding 

that the elected official position 

qualified for IMRF Form 6.64, if not 

previously filed, 

AND 

Certify member’s wages and months of 

qualifying elected official service on 

Form 6.04, Application for Retroactive 

Service Credit. 


approve and file a resolution finding 

that the elected official position 

qualified for IMRF Form 6.64, if not 

previously filed, 

AND 

Before January 1, 2002, governing 

body must have passed a resolution 

allowing more than 50 months of 

retroactive service credit for elected 




Member will take a leave of absence 

from his or her job. While on leave, 

member wants to earn IMRF service 

credit and wants IMRF disability and 

death protection to continue. 

Member has service credit with a public 

pension system in another state and 

wishes to convert it to IMRF service 

credit. 

Member participates in the Elected 

County Officials (ECO) plan and wants 

to convert his or her existing SLEP or 

Regular service credit to ECO service 

credit. 

SLEP member wishes to convert up to 

120 months of Regular plan service to 

SLEP service if they joined before 

August 8, 2011. Members who join the 

SLEP plan on or after August 8, 2011 are 

not eligible to upgrade Regular service 

credit to SLEP. 

Police Chief elected to participate in 

SLEP and wishes to transfer service as a 

police officer 

Benefit Protection Leave 

Form 6.32. (Note: Member 

should file this form before 

his or her leave begins.) 

Out-of-State Service 

Form 6.33 

Conversion of service 

credit 

Form 6.06 

Conversion of Regular 

Service Credit to SLEP 

Form 6.09 

Election of Police Chief to 

Participate as a SLEP 

Member 

Form 6.22 

officials, Form 6.81. 

AND 

Certify member’s wages and qualifying 

elected official service on Form 6.04, 

Application for Retroactive Service 

Credit. 

Governing Body must choose to 

authorize the leave and agree to pay the 

estimated employer costs. Certify 

member’s wages and months of leave 

on Form 6.32, IMRF Benefit Protection 

Leave. 

Governing Body must choose to 

authorize purchase of service and the 

amount purchased on Form 6.33, Outof-State 

Credit Authorization. 

None 

None 

Certifies the date the police chief was 

appointed. 

Past service credits are granted for service performed and earnings paid in a time period prior to January 1 of the 

current calendar year. The current calendar year is defined as the period between January 1 and December 31. 

Gaps in service credit can create problems for members who apply for IMRF benefits. Some examples of problems 

that can occur are: 

1. Denial of disability benefits (see paragraph 5.40 Disability Benefits). 

2. Denial of retirement benefits (see paragraph 5.20 Retirement Pensions). 

3. Delay in benefit processing. 

Occasionally, a member may wish to purchase a month(s) of past service which results in the member having 

concurrent service. Concurrent service occurs when a member is reported by more than one employer and/or under 

more than one plan in a single month. This may or may not be beneficial to the member. Refer to paragraph 6.40 C. 

Member Application and Payments for details. 

Information for Members 

IMRF developed a booklet for members, “Purchasing Past Service from IMRF,” which explains the past service 

purchase process, including an explanations of the types of past service, requirements for each, and how to purchase. 



Members can obtain the “Purchasing Past Service from IMRF” booklet by contacting IMRF or by downloading a copy 

from the IMRF website, www.imrf.org. 

6.40 1. Military Leave - “Application for Service Credit During Military Leave As Provided By The 

Illinois Pension Code” (Form 6.02J, Exhibit 6E) 

IMRF members can receive service credit for time spent in the military under two separate provisions of the 

Pension Code (Paragraphs 1(A) and 1(B) below) or under federal law (Paragraph 2 in this section). 

Regardless of the statute the member is applying under, the form used is Form 6.02J, “Application for 

Military Service Credit.” 

Under the Pension Code, a member may earn service credit under two different provisions depending on the 

circumstances surrounding the military leave: 

a. The member earned the military service before his or her first date of IMRF participation or member 

did not return to IMRF participation within 90 days of discharge 

OR 

b. Military leave interrupted the member’s IMRF participation and the member returned to IMRF 

participation within 90 days of discharge 

A. Military service earned prior to IMRF participation or member did not return to IMRF participation 

within 90 days of discharge 

.Under this provision a member can purchase up to four years of military service credit if the: 

1. Military service occurred before the member began participation in IMRF, or 

2. Member did not return to IMRF participation within 90 days of discharge 

If a member purchases military service under this part of the Pension Code, he or she may still use 

the service in the computation of a pension or retirement pay from the U.S. government. 

The member’s employer must adopt a resolution (IMRF Form 63A) allowing its member to 

purchase up to four years of military service. Refer to paragraph 6.60 C. To Allow Service Credit 

for Military Service prior to IMRF Participation. 

a. Eligible members 

A member must be participating in IMRF to purchase military service under this provision of the 

Pension Code. A member would be eligible to purchase military service under this provision if the: 

Member was participating in IMRF on or after the date his or her employer adopts the authorizing 

resolution and the member was participating in IMRF on the date IMRF receives the member’s 

application. 

b. Adopting the resolution 

This type of military service credit is available only if the employer agrees to it. Employer adoption of 

the resolution (Form 63A) allowing military service credit under this statute is optional. Refer to 

paragraph 6.60 C. To Allow Service Credit for Military Service prior to IMRF Participation. 

c. Ineligible members 

A member would not be eligible to purchase military service under this statute if the: 

i. Member’s previous IMRF employer adopts the resolution. The member’s current employer 

must adopt the resolution allowing him or her to purchase the service. A member cannot 

purchase military service based on a previous employer adopting the resolution. 

ii. 

Employer rescinds the resolution before the member is hired. 




iii. 

Member received a discharge that does not qualify for veteran’s benefits, such as a 

dishonorable discharge. 

d. Eligible military service 

Eligible members are able to purchase the following military service and convert it to IMRF service: 

i. Regular service in the United States Armed Forces 

ii. 

iii. 

iv. 

Reserve duty (active or inactive) 

National Guard duty (active or inactive) 

Public Health Service commissioned duty 

e. Ineligible military service 

The following service cannot be converted to IMRF service: 

i. Peace Corps work 

ii. 

ROTC 

f. Member application process 

A member must apply in writing by completing Form 6.02J, “Application for Military Service Credit,” 

and attaching a copy of his or her DD Form 214 (Armed Forces of the United States Report of 

Transfer or Discharge). 

g. Online spreadsheets to estimate member and employer costs 

The cost to the member of converting military service to IMRF service varies widely depending on 

when the military service occurred, when the member began IMRF participation, and the member’s 

salary upon participation. 

IMRF has developed spreadsheets that allow you to estimate the total cost for this program, the 

member cost, and the resulting difference which is the employer cost. The incremental employer costs 

are paid through future employer contribution rates. 

To download these Excel spreadsheets, visit www.imrf.org/legislation/PA_95-0486.htm. Employers 

without web access can contact IMRF and receive a copy of the spreadsheets. You will need Microsoft 

Excel installed on your computer to use these spreadsheets. 

h. Member costs 

The cost of military leave to the member varies widely depending on when the military service 

occurred, when the member began IMRF participation, and the member’s salary upon participation. 

The member’s first IMRF salary is to be used in the calculation of member costs, assuming the 

member did not take a refund. If the member took a refund, IMRF uses the first salary as of the 

member’s most recent uninterrupted IMRF participation date. 

The member pays: 

The member contributions in effect at the time of the military service. Contributions are based on 

the member’s salary when he or she first began participating in IMRF (see paragraph above), 

Plus: Employer “normal cost” contributions (“normal cost” is the rate which would have been 

required to fund pension benefits if the member had remained in IMRF until an assumed 

retirement age.) 

Plus: Interest from the beginning of the member’s first IMRF participation date to December 31 st 

of the year prior to the date of payment. (Currently, the interest rate is 7.50%.) 

The member may purchase the service credit in a lump sum or on a payment plan. Refer to Paragraph 

6.40 C. Member Application and Payments for details. 



i. Employer costs 

The cost of military leave to the employer equals the difference between the value of the increased 

benefit to the member and the contributions paid by the member. Therefore, the eventual employer 

cost is dependent upon the member’s benefit and the member’s payment. This can be expressed as 

follows: 

Estimated cost for the increase in member’s benefit 

Less: Member total cost for military leave 

Equals: Estimated employer cost (b) 

j. Estimated cost for the increase in member’s benefit 

The exact increase in the member’s benefit cannot be determined until the member retires. To 

calculate the exact amount IMRF must know: 

1. The age of the member at retirement 

2. The amount of service the member has upon retirement 

3. The amount of the member’s final salary 

4. Whether the member has an eligible spouse 

IMRF developed guidelines for estimating the costs for the increase in member’s benefit if the 

member purchased two years of military service. Multiply the member’s current salary times the cost 

factor to estimate the total cost for the increase: 

Member Age When 

Purchasing the Service 

Increase in Member’s Benefit 

Age Based Cost Factor 

Less than 35 22% 

35 to 40 29% 

41 to 45 37% 

46 to 50 47% 

51 to 55 60% 

56 to 62 55% 

63 to 67 50% 

68 to 73 45% 

k. Estimated employer cost 

The difference between the increase in the member’s benefit and the member’s cost is the employer 

cost. The employer cost is paid through future employer rates. 

l. Examples of member and employer costs 

Assume an employer has three eligible members with an annual increase in payroll of 4%. The chart below shows 

their current and starting salaries, years of service credit and their member costs for purchasing two years of military 

service: 




Member 

A 

Member 

B 

Member 

C 

Age 28 55 40 

Current Salary $15,000 $35,000 $45,000 

Starting Salary $12,000 $17,500 $22,500 

Years With Employer 5 years 15 years 10 years 

Total 

Member Costs: $2,739 $8,357 $7,383 

Age-Based Factor 22% 60% 29% 

Increased Cost 

(Factor x Current Salary) $3,300 + $21,000 + $13,050 = $37,350 

Employer Cost: $561 + $12,643 + $5,667 = $18,871 

If members’ salaries increases are greater than the 4% assumption, there is a greater cost to the 

employer than illustrated in the example above. Because the member cost is fixed, the cost burden of 

an increased salary is passed on to the employer. The employer cost is paid through the employer’s 

future contribution rate. 

B. Military leave interrupted the member’s IMRF participation and the member returned to IMRF 

participation within 90 days of discharge 

Members may also be granted military service under a different section of the Pension Code. If a member 

receives military service under this provision, he or she may not use the service in the computation of a 

pension or retirement pay from the U.S. government. 

A member who leaves participating employment to serve in the Armed Forces of the United States may 

receive service credit for the time served by submitting Form 6.02J, if: 

a. Within 90 days of discharge he or she returns to IMRF participating employment. The member can 

return to an IMRF-covered position for any IMRF employer within 90 days of discharge. The member 

is not required to return to the same IMRF employer he or she participated with prior to the military 

service. 

b. The governmental unit he or she is employed with has on file resolution Form 6.62 (unlimited service) 

or Form 6.62A (limited service) authorizing service credits for military leave. 

c. The member certifies that the military service will not be used in the computation of a pension or 

retirement pay from the U.S. government. 

d. The member encloses a copy of his or her discharge papers. 

e. The member’s military period is for active duty service. 

No immediate payment is required of the employer, but the cost will be reflected in the employer’s future 

contribution rate. There is no cost to the member. 

6.40 2. Military Leave - Application For Service Credit During Military Leave As Provided By The 

Uniformed Services Employment and Re-employment Rights Act (Form 6.02J, Exhibit 6E) 

An IMRF member who leaves participating employment because he or she was drafted, enlisted for regular 

military service, or performed active duty in a reserve or national guard unit of the United States Armed 

Forces, may receive service credit for military leave under federal law by submitting Form 6.02J, if the 

member meets the following requirements. 



a. The IMRF or reciprocal member does not qualify for service credit during the military leave under the 

IMRF statute because: 

1. The employing governmental unit does not have on file with IMRF a resolution Form 6.62 

(unlimited service) or Form 6.62A (limited service), nor does the governmental unit intend to 

adopt a resolution to allow service credit for periods of military, or 

2. The employing governmental unit has filed resolution Form 6.62 or Form 6.62A, but the member 

certifies that the military service will be used in the computation of a pension or retirement pay 

from the United States government. 

b. The member left and returned to participating employment with the same IMRF governmental unit. 

The federal law does not apply if an IMRF member returns to work for another IMRF employer. 

c. The member returned to participating employment with the same governmental unit within the number 

of days required under the Uniformed Services Employment and Re-employment Rights Act. IMRF 

must receive documentation from the member’s military service organization certifying the date the 

member was released to return to work. 

d. The member pays the required member contributions. The contributions shall be computed upon the 

assumption that earnings continued during the period of military leave at the rate in effect when the 

leave began. The member may purchase the service credit in a lump sum or on a payment plan. Refer 

to Paragraph 6.40 C. Member Application and Payments for details. 

e. No immediate payment is required of the employer. The cost will be reflected in the employer’s future 

contribution rate. 

f. The member’s military period is for active duty service. 

6.40 3. Reinstatement (Repay a refund) - “Application for Reinstatement of Service Credit”(Form 

6.03, Exhibit 6F) 

A member who has received a separation refund may reinstate the forfeited service credits by submitting 

Form 6.03 (paper form or via Member Access) if he or she: 

a. Returns to participating employment under an IMRF employer 

b. Participates under another Illinois public pension system covered by the Illinois Reciprocal Act and 

c. Has rendered two years of contributing service under (a) or (b). (Prior service is not considered 

contributing service. See paragraph 6. Prior Service in this section.) Exceptions to the two years of 

contributing service: 

i. Employees who return to IMRF participation as a Sheriff’s Law Enforcement Employee 

(“SLEP”) can repay the refund immediately.| 

ii. 

Employees who return to work under a grievance arbitration award/settlement agreement or a 

court ordered award/settlement agreement can repay a refund prior to two years of 

participation, so long as the award/settlement agreement specifically provides for such 

repayment. 

Payment of the separation refund plus interest will reinstate service credit. 

The member may be eligible to use funds from a traditional Individual Retirement Account (IRA) or from 

another qualified plan or 457 or 403(b) plan to repay the refund and reinstate the past service credit. (See 

paragraph 6.40 C. Member Application and Payments.) 

6.40 4. Retroactive - “Application for Retroactive Service Credit” (Form 6.04, Exhibit 6G) 

Certain groups of members who rendered qualifying service prior to their enrollment in IMRF may obtain 

past service by submitting Form 6.04 “Application for Retroactive Service Credit” and paying the required 

contributions plus interest. 

Form 6.04 must be filed while the applicant is still participating in IMRF or covered by a reciprocal 

retirement system. Members eligible for retroactive service credit include: 




a. Elected officials and city hospital employees who rendered qualifying service prior to their election of 

membership in IMRF. They may obtain up to 50 months (over their lifetime) of past service credit. A 

standing resolution (Form 6.64 “Resolution - Elected Officials,”) must be on file establishing the 

annual hourly requirements of positions held by elected officials (see paragraph 3.65 Participating 

Members). 

EXCEPTION: An elected official will be eligible to purchase more than 50 months of past service 

credit if the governing body adopted the appropriate resolution (IMRF Form 6.81, “Resolution To 

Allow More Than 50 Months of Retroactive Service Credit for Elected Officials,”) prior to January 1, 

2002. 

b. If the governing body did not adopt the resolution, the elected official will be limited to 50 months of 

past service. 

c. Members who rendered qualifying service between January 1, 1956, and July 1, 1957, and were 

required to wait one year before being enrolled. 

d. Employees of township road districts that became participating IMRF employers on June 1, 1974, as 

part of a township. 

e. ROTC instructors who rendered qualifying service prior to October 1, 1977, the date this position was 

covered under IMRF. 

Form 604A , Application for Retroactive Service Credit for Employees Previously Barred by Age has been 

discontinued. 

If you have as an employee who was not eligible for IMRF participation when first hired because he/she was 

over the maximum age (over age 60 before 1981 or age 70 before September 1, 1989), please contact IMRF 

for instructions. 

6.40 5. Omitted Service - “Omitted Service Credit Verification” (Form 6.05, Exhibit 6I) 

Members who work or have worked in IMRF covered positions but who have never been reported as such 

may obtain past service credits for the period of omission by submitting Form 6.05 “Omitted Service Credit 

Verification” and paying the contributions. (Effective March 1, 2008, employers are responsible for paying 

the interest on omitted service.) The application for omitted service must be received by IMRF while the 

member is participating in IMRF. If a member participating in Tier 2 purchases omitted service which 

changes the member’s earliest participation date to before January 1, 2011, that member will be reclassified 

as participating in Tier 1. 

Payment of member contributions is required from the member to establish the omitted service (interest 

charges may apply). The member may be eligible to use funds from a traditional Individual Retirement 

Account (IRA) or from another qualified plan or 457 or 403(b) plan to purchase the omitted service credit. 

(See paragraph 6.40 C. Member Application and Payments.) No immediate payment is required of the 

employer, but the cost will be reflected in future contribution rates. 

PLEASE NOTE: 

a. Use Form 6.05 “Omitted Service Credit Verification” for a member whose earnings and 

contributions have never been reported. Refer to the reverse side of the form for specific 

requirements. 

b. Submit Form 3.20, “Employer’s Report of Adjustment to IMRF Earnings” for a member who was not 

reported but had contributions withheld or to correct earnings and contributions previously 

reported to IMRF. Because online transactions are more accurate, more efficient, and faster than 

submitting member information to IMRF via paper forms, effective March 1, 2009, employers with 

Internet access must submit wage adjustments via Employer Access. 



6.40 6. Prior Service - “Application For Prior Service Credit” (Form 6.07, Exhibit 6K) 

The Pension Code provides for service credit for qualifying employment before the employer (unit of 

government) joined IMRF. This type of service credit is called prior service credit. 

a. Unit of government joined IMRF on or before January, 1, 1998 

Members who rendered service in an IMRF covered position prior to the date their governmental unit 

entered IMRF may receive all of their prior service credit at no cost to the member. 

b. Unit of government joined IMRF after January, 1, 1998 

Members who rendered service in an IMRF covered position prior to the date their governmental unit 

entered IMRF may receive five years of their prior service credit or 20 percent of their total prior 

service, whichever is less, at no cost to the member. 

The member can purchase any remaining prior service by paying the member contributions, plus 

interest. A member’s eligibility to purchase the remaining years of service is not discretionary with the 

unit of government. The salary used to calculate the cost to purchase the prior service is the salary as 

of the date the unit of government joined IMRF. 

The member may be eligible to use funds from a traditional Individual Retirement Account (IRA) or 

from another qualified plan or 457 or 403(b) plan to purchase the prior service credit. (See paragraph 

6.40 C. Member Application and Payments.) 

Regardless of when the unit of government joined IMRF, a member would apply for prior service by 

submitting Form 6.07 under the following conditions: 

1. The member must be employed in a covered position on the date the governmental unit enters 

IMRF, or 

2. The governmental unit entered IMRF but has now returned to work for that governmental unit and 

has completed two years of contributing service after re-entry. 

There is no immediate payment required of the employer. The cost to the governmental unit is 

reflected in its future employer contribution rates. 

6.40 7. Leave of Absence - “IMRF Benefit Protection Leave” (Form 6.32, Exhibit 6Y) 

Members who take an authorized IMRF Benefit Protection Leave may receive service credit for up to a 

maximum of 12 months over their entire career, provided they pay the IMRF member contributions plus 

applicable interest, and the governing body adopts an authorizing resolution. Benefit Protection Leave service 

is only for periods the member was on unpaid leave. 


another qualified plan or 457 or 403(b) plan to pay for the leave of absence. (See paragraph 6.40 C. Member 

Application and Payments.) 

To establish the credits, Form 6.32 (Exhibit 6Y) may be filed before, during, or anytime after the leave 

period, provided the member is still actively participating in IMRF or a reciprocal system. 

No immediate payment is required of the employer. The cost will be reflected in future contribution rates. 

A member on an authorized IMRF Benefit Protection Leave will be afforded IMRF death and disability 

protection if, before the leave period begins, the member has at least one year of contributing service and 

Form 6.32 is filed with IMRF. An IMRF Benefit Protection Leave application filed after a disability or death 

occurs will not retroactively qualify the member nor his or her beneficiaries for benefits. 

When an IMRF Benefit Protection Leave is taken in conjunction with any paid sick leave, bonus day, 

vacation time, or other paid leave, the leave of absence officially starts when the paid leave ends (where paid 

leave is taken prior to the official leave of absence), and officially ends when paid leave begins (where paid 

time follows the leave of absence). 




a. Family Medical Leave Act 

The Family Medical Leave Act (FMLA) requires certain public employers to give eligible employees 

time off to care for: 

1. Newborn or newly adopted children 

2. Seriously ill family members 

3. The employee’s own illness 

4. A relative injured on active military duty, or 

5. A qualifying emergency related to a family member’s call-up to active military duty. 

Eligible employees are entitled to a total of 12 weeks (26 weeks for relatives injured on active military 

duty) of FMLA leave each year. This federal law does not require that an employee on FMLA leave be 

paid, but the employee’s health insurance benefits must continue. The employee also is entitled to 

return to his or her former position with no loss of seniority or status. 

b. FMLA eligibility 

The general provisions of the FMLA apply to all public sector employers. However, not all public 

sector employees are eligible for FMLA leave. An employee is eligible for FMLA leave if he or she: 

1. Has worked for the employer for at least 12 months (the 12 months need not be consecutive) and 

2. Has worked at least 1,250 hours in the preceding 12 months. 

The employer is not required to grant FMLA leave to an employee if the employer has fewer than 50 

employees within 75 miles of that employee’s work site. This means that an IMRF employer with 

fewer than 50 employees is not mandated by this law to grant FMLA leave. (The 50 employees include 

everyone who works for the employer, regardless of the number of hours the employees work or 

whether they participate in IMRF.) 

Employers are not required to grant a Benefit Protection Leave, with the exception of Leaves requested 

by employees on FMLA in certain circumstances. Employers should consult their legal counsel before 

denying a BPL requested by a member on FMLA. 

c. Effect of the Family Medical Leave Act on IMRF Benefit Protection Leave 

An IMRF Benefit Protection Leave usually is granted at the discretion of the employer. However, if a 

member on FMLA leave requests an IMRF Leave, FMLA regulations require the employer to grant 

the IMRF Leave, if the employer ever granted an IMRF Leave to any member in the past. 

However, if an employer has never granted an IMRF Benefit Protection Leave and a member on 

FMLA leave requests one, the employer is not required to grant the leave under this legislation. 

An IMRF Benefit Protection Leave remains limited to 12 months of service credit over the member’s 

entire IMRF career. 

d. Effect of FMLA on IMRF death and disability benefits 

IMRF members on FMLA leave will remain eligible for IMRF disability and death benefits if they 

were eligible for those benefits when the leave began. FMLA leave will not interrupt IMRF disability 

and death benefit protection. 

The usual rules require an IMRF member to have 12 months of continuous service credit in order to be 

eligible for IMRF disability benefits. This rule will not apply if a member’s gap in IMRF service is due 

to an FMLA leave. 

e. Effect of FMLA on IMRF retirement benefits 

IMRF members on FMLA leave will not earn pension service credit for the month(s) in which they are 

not paid. If a member on FMLA leave wishes to receive IMRF pension service credit, the member 

must apply for an IMRF Benefit Protection Leave and pay the member contributions and any 



applicable interest. A member on an IMRF Benefit Protection Leave is afforded the opportunity to 

establish pension service credit even though the member is not being paid. 

6.40 8. Out-of-State Service - “Out-of-State Service Credit Authorization” (Form 6.33, Exhibit 6Z) 

Members who rendered service for a local government in another state and participated in a public employee 

retirement program may receive past service credit of up to 10 years with their current IMRF employer. 

Out-of-state service cannot be established for service to a state government. This includes various state 

entities, e.g., state universities and colleges, department of transportation, social services, etc. 

Form 6.33 must be filed and: 

a. The governing body must adopt an authorizing resolution. 

b. The member must have irrevocably forfeited all benefits in the out-of-state system. 

c. The member must have completed two years of contributing service with the current IMRF 

governmental employer authorizing the out-of-state service. 

d. The member must pay IMRF contributions for each month of out-of-state service equal to 10% times 

the average monthly earnings for the first 24 months of reported earnings with the employer 

authorizing the out-of-state service. Interest is added to the amount from the end of the two-year 

qualifying period until the December 31 st preceding the current year. 


another qualified plan or 457 or 403(b) plan to purchase the out-of-state service credit. (See paragraph 6.40 C. 

Member Application and Payments.) 

No immediate payment is required by the employer. The cost will be reflected in future employer 

contribution rates. 

6.40 9. Retroactive Service by General Assembly Members - “Application by Member of the 

General Assembly for Service Credit Authorization as Elected Official” (Form 6.34, Exhibit 6AA) 

Members of the General Assembly who did not previously establish IMRF credits for services rendered as an 

elected official for a participating IMRF governmental employer may obtain credit for such service by paying 

required IMRF contributions plus interest. The member may be eligible to use funds from a traditional 

Individual Retirement Account (IRA) or from another qualified plan or 457 or 403(b) plan to purchase the 

retroactive service credit. 

To apply for service credit, the member must file Form 6.34, “Application by Member of the General 

Assembly for Service Credit as an Elected Official.” 

A standing resolution (Form 6.64,“A Resolution Relating to Participation by Elected Officials in the Illinois 

Municipal Retirement Fund,”) must be on file establishing that the elected position held previously by the 

General Assembly member qualified for IMRF coverage. 

The General Assembly member can then request transfer of his or her service and credits to the General 

Assembly Retirement System, or, the member can leave these credits on deposit with IMRF for future 

retirement. If the member’s credits are transferred, there is no employer cost. If credits remain on deposit with 

IMRF, no immediate payment is required of the employer, but the cost will be reflected in future employer 

contribution rates. 

6.40 10. Certificate of Sheriff’s Law Enforcement Service (Form 6.71, Exhibit 6HH) 

Members who qualified for SLEP service but were reported under the Regular plan are eligible to have their 

service credit adjusted. To begin this process, the sheriff must certify that the member was a sworn deputy 

sheriff eligible for SLEP participation. Use IMRF Form 6.71, “Certificate of Sheriff’s Law Enforcement 

Service.” In some situations, IMRF will require that additional documentation be submitted verifying that the 

position qualifies for SLEP coverage. 




The adjustment is reported to IMRF via Employer Access. Because online transactions are more accurate, 

more efficient, and faster than submitting member information to IMRF on paper, employers with internet 

access must submit wage adjustments via Employer Access. See Paragraph 2.90 Secure Employer Access 

Area of www.imrf.org for details. 

6.40 11. Conversion of Regular or SLEP Service Credit to Elected County Official (ECO) Service 

Credit (For earnings previously reported to IMRF) (Form 6.06, Exhibit 6J) 

Members who participate in the Original Elected County Official (ECO) plan (joined ECO prior to January 

26, 2000) and who have any existing Regular or SLEP service can convert that service to ECO. The cost of 

converting this service depends upon the member’s original contributions. 

If a member participates in Revised ECO (joined ECO on or after January 26, 2000), he or she can convert 

only service earned as an elected county officer to ECO. Use Form 6.06, “Conversion of Regular or SLEP 

service credit to Elected County Official (ECO) Service.” 

6.40 12. Conversion of Regular Service to SLEP Service (Form 6.09, Exhibit 6TT) 

Certain members who participate in the SLEP plan and who have any existing Regular service can convert 

that service to SLEP. The SLEP member can convert a maximum of 120 months of Regular Plan service to 

SLEP. For the service to be eligible for conversion to SLEP, the Regular Plan service must be followed by 

SLEP service. 

The cost of converting the service includes the additional SLEP contributions, plus additional employer 

contributions, plus interest from the date of the service to the date of payment. Use Form 6.09, “Conversion 

of Regular service credit to SLEP Service” (Exhibit 6TT). 

Members who join the SLEP plan on or after August 8, 2011 are not eligible to upgrade Regular service 

credit to SLEP. 

6.40 13. Transfer of Local Police Pension Fund Service into IMRF by Police Chief 

(Form 6.22, Exhibit 6T) 

Appointed police chiefs of cities, towns and villages that have formed their own police pension fund under 

Article 3 of the Illinois Pension Code have the option to participate in either the local police pension fund or 

in IMRF SLEP. (See Paragraph 3.80C) 

If a police chief elects to join IMRF’s SLEP program, the police chief may transfer into IMRF service credit 

previously established in any Illinois police pension fund. Use Form 6.22, “Election of Police Chief to 

Participate as a SLEP Member,” 

The transferred service credit would be recognized as SLEP service credit. The local police pension fund 

would transfer an amount equal to: 

a. The amounts accumulated to the police chief’s credit on the books of the police pension fund on the 

date of transfer, plus 

b. Matching employer contributions, plus 

c. Any interest the police chief paid to reinstate service with the police pension fund. 

If IMRF determines that the amount transferred is less than the true cost of the service to be established, to 

establish that service, the police chief must pay to IMRF an additional contribution equal to the difference. 

The true cost of the service to be established is the police chief’s full actuarial cost of the transfer to SLEP. 

When a police chief transfers service credit into the IMRF SLEP plan from a downstate police pension fund, 

the police chief’s cost for the transfer is the difference between the: 

 

 

Amount of money the local police pension fund transfers to IMRF, and 

Actuarially calculated value of the police chief’s total pension. 



If the police chief does not make the full additional payment prior to termination of his participation with that 

employer, then his or her service shall be reduced by an amount equal to the difference between the amount 

transferred, including any payments made by the police chief prior to termination, and the true cost of the 

service to be established. 

DO NOT report the police chief’s wages and contributions until the following steps are completed. 

1. Obtain an estimate of the costs for the chief to transfer police pension fund service to the SLEP 

program. 

2. Determine whether IMRF’s SLEP Plan is advantageous to the police chief. 

3. Determine whether transferring in or reclassifying service is appropriate for the police chief’s 

circumstance. 

6.40 14. Transfers to State Employees’ Retirement System (Form 6.92, Exhibit 6WW) 

Public Act 95-0530 allows former IMRF members who participated in SLEP but now participate in SERS as 

a state police officer, conservation police officer, or, investigator for Secretary of State to transfer their IMRF 

SLEP service to SERS. SERS can accept up to five years of transferred service. They can also reinstate their 

refunded SLEP service at a reduced interest rate. 

To transfer the service, the member would complete IMRF Form 6.92, “IMRF Transfer to State Employees 

Retirement System (SERS Alternative Retirement Formula Plan) Under Public Act 95-0530.” 

The member can apply for this transfer at any time; there is no deadline for application. 

If the member took a refund of his or her IMRF service credit, the member can repay the refund at a reduced 

interest rate and reinstate the service. The former member can indicate that he or she has service to reinstate 

on Form 6.92. 

The member’s cost to reinstate the service will be calculated using a reduced interest rate of 6% (instead of 

the normal 7.50%). Once the member receives a Past Service Payment Schedule from IMRF, he or she can 

repay the refund at any time in order to transfer the service; no deadline exists for repayment of the refund. 

However, if the member reinstates the SLEP service at the reduced interest rate, the reinstated service must 

be transferred to SERS; it cannot remain on deposit with IMRF. 

6.40 A. General Requirements for Past Service Applications 

All past service shown on the application must have been rendered in an IMRF covered position. Credits cannot be 

granted for service in a position which at the time of service did not qualify for IMRF coverage. 

All applications for service credits must be received while the member is in an active IMRF status (contributing, on 

authorized IMRF Benefit Protection Leave, on seasonal leave, or receiving disability benefits). Certain kinds of 

past service applications can be accepted if the applicant is actively participating in a retirement system under the 

Retirement Systems Reciprocal Act (See Paragraph 5.50 Reciprocity). 

Payment for service credits must be received while the member is in an active IMRF status. However, one final 

payment may be made after termination. That one payment may affect retirement claims and the time needed to 

pay the benefit. Reciprocal members need to have a minimum of 12 months of IMRF service credit for their service 

to be considered and used for service credit under the Reciprocal Act. 

The entire payment is credited to the member’s account as contributions. The interest charged represents the 

amount of interest that would have accumulated on the contributions had they been on deposit with IMRF. The 

interest that is included in the payments by the member for past service credits is not tax deductible. 

If a member purchases service through IMRF’s Unit Payment System (see Paragraph 6.40 C. Member Application 

and Payments), those payments are recorded as previously taxed (after-tax) member contributions. The 




contributions and interest are not deductible for federal income tax purposes. However, they are considered an 

additional cost of the member’s retirement pension. When the member retires, that cost will be recovered (paid to 

the member tax free). 

If a member uses tax-deferred funds from an eligible rollover, e.g., another qualified plan or a traditional IRA, Roth 

IRA, 457 or 403(b) plan, the past service payment is recorded as tax-deferred member contributions. The member 

must contact IMRF before payment is made to determine if a rollover is possible. (Form 6.01, “Request for 

Rollover Approval for Past Service.”) 

If the member expects to retire within one year of submitting the past service application, the expected 

retirement date should be indicated on all forms submitted to IMRF. Any adjustments to a member’s account 

should be submitted early to provide ample time to expedite retirement pension requests. 

6.40 B. Authorization 

Before past service can be recorded in the member’s account, 

1. The governing body must adopt or have adopted an authorizing resolution, 

2. The member may be required to pay contributions plus interest, or 

3. Both 1 and 2 may be necessary. 

If adoption of a resolution by the governing body is required, a copy of the resolution should accompany the 

member’s application. If an authorizing resolution had been adopted previously, this standing resolution must be on 

file with IMRF and be referred to on the member’s application. 

6.40 C. Member Application and Payments 

1. Application for past service credits 

An IMRF member wishing to establish past service must file an application or a letter of intent with IMRF 

before he or she terminates participating employment with the IMRF or reciprocal systems employer. 

2. Concurrent service resulting from past service purchase 

When a member applies for any type of past service, IMRF researches the member’s file to determine if the 

purchase would result in the member having concurrent service. 

Concurrent service occurs when a member is reported by more than one employer and/or under more than 

one plan for the same month. However, the member is credited with one month only of service credit. 

(Exception: If a member concurrently participates in the Regular Plan and the SLEP Plan. If the member 

vests for a SLEP pension, when the pensions are calculated, each concurrent month will be treated as one 

month in two plans. When the pension is calculated, the calculation will apply the Regular formula to those 

months with Regular wages and the SLEP formula to those months with SLEP wages.) 

Purchasing past service which is concurrent with other service is not always beneficial to the member. If a 

past service purchase will result in concurrent service, IMRF will advise the member. The member will be 

asked to sign a form indicating that he or she understands that the purchase will result in concurrent service, 

and that the concurrent service will benefit the member only if it occurs during the time period used to 

compute the member’s earnings for the pension. 

3. Application and payment dates 

Although an IMRF member must make application for past service credits before he or she terminates 

participating employment with an IMRF or reciprocal systems employer, one payment for past service can be 

accepted after the termination date. 



Retired IMRF members receiving IMRF pensions will have their pensions recalculated after payment is 

received. The higher benefit amount will be effective the month after IMRF receives the payment for past 

service. For example, If the payment is received in July, the higher benefit will be effective in August. 

4. Payment Plans 

Member payments apply to specific types of past service that require payments from the member to IMRF. 

Those types of past service are: 

Omitted service 

Prior service 

Retroactive service 

Reinstatement of forfeited service (repayment of a refund) 

Benefit Protection Leaves for unpaid absences 

Military service under the Uniformed Services Employment and Re-employment Rights Act 

Certain military service under Illinois law 

Elected County Official Plan service 

Out-of-state service rendered with a local governmental employer in another state covered by a public 

employee retirement program. 

Conversion of Regular Plan service to SLEP Plan service 

Member payments for past service may be remitted in a lump sum paymentor in monthly unit payments 

remitted by the member, or in monthly tax-deferred installments: 

a. The Lump Sum Plan allows the member to purchase all past service credits with a one-time single 

lump sum payment. The lump sum payment may be made with after-tax funds or with a rollover 

using tax-deferred funds. 

b. The Unit Payment Plan allows a member to pay past member contributions and interest in 

installments (i.e., “unit payments”). Members may purchase one or more months (one or more 

“units”) of past service at a time. However, members may not purchase fractions of a month, nor can 

they purchase more than the number of months indicated on the payment schedule. The frequency 

and number of months purchased can be determined and paid for at the member’s convenience. 

IMRF members are advised of payment options when they apply for past service. The payment plans are 

offered and explained in a Payment Schedule which is issued to the member after a properly executed past 

service application has been filed and accepted by IMRF. 

If the member is using the Lump Sum or Unit Payment Plan, the member may be able to use tax-deferred 

funds from a traditional Individual Retirement Account (IRA) or from another qualified plan or 457 or 403(b) 

plan to purchase part or all of the past service credit. The member would request from IMRF Form 6.01, 

“Request for Rollover Approval for Past Service”. 

. 

The member and a representative from his or her qualified plan or financial institution would complete the 

form. After IMRF receives the completed form, we will determine if the funds are eligible for rollover into 

IMRF and advise the member accordingly. 

If employer pays the member cost: 

In situations where an employer agrees to pay the member’s cost, the employer must treat the payment as 

earnings paid to the member. All applicable deductions must be withheld. (See Paragraph 4.24 I. Employer 

Paid Member Contributions.) 




The employer would submit the payment as a First Data Government Solutions Electronic Funds Transfer 

(EFT) payment and identify the EFT as “After Tax Payment for Member Past Service.” 

6.40 D. Account Corrections Due to Court Order/Settlement of Litigation/Grievance Resolution 

A correction to a member’s account may be required by a court order, the settlement of a lawsuit, or the resolution 

of a grievance. The court order or settlement agreement must affirmatively state that back salary is being paid to 

the member in order for IMRF to grant past service credit. The exact time period covered for the back salary must 

be specified in the order. A mere statement that the member is to be given service credit is not sufficient. 

These account corrections should be reported to IMRF on Form 3.20, “Employer’s Report of Adjustments to IMRF 

Earnings,” (Employer Access web transmittal or paper Form 3.20) for current and past year corrections. 

Because online transactions are more accurate, more efficient, and faster than submitting wage adjustments to 

IMRF via paper forms, employers with Internet access must submit wage adjustments via Employer Access. 

Notification may also need to be submitted to the Social Security Administration. The IRS does not make 

corrections to past year Social Security records. This must be done with the Social Security Administration. 

For both current and past year corrections, a copy of the court order, settlement agreement, or grievance resolution 

must accompany Form 3.20 or be mailed to IMRF after submitting a web wage adjustment. After IMRF has 

audited the documents submitted for the account correction, we will send a remittance advice to the employer 

showing the member and employer contributions due. 

NOTE: The Illinois Pension Code requires that IMRF members make contributions of 4.5% (7.5% for SLEP 

members, 7.5% for ECO members) of salary for their pensions. If the employer makes that payment on behalf of 

the employee, it is additional income to the employee which must be reported for federal, state, and Social Security 

tax purposes, and to IMRF. This is true even if the employer is required to make the payment on behalf of the 

employee by a court order, settlement agreement, or grievance resolution. 

6.50 Annual Personal Statement of Benefits 

6.50 A. Personal Statement of Benefits (Exhibit 6A) 

Each year, IMRF issues annual statements that report the transactions and service credits accumulated by each 

member. These statements report the service credit and contributions accumulated under each governmental unit. 

Members can also view their annual Personal statement of Benefits via the Document Archive of online Member 

Access. 

A member can receive only one month of service credit for one calendar month, regardless of the number of 

governmental units employing the member. For a discussion of concurrent service, refer to paragraph 6.40 C. 2. 

Concurrent Service. 

The annual Personal Statement of Benefits provides: 

Total service credit by plan (e.g., Regular, SLEP, ECO ) 

Total member contributions 

Member contributions made under each employer 

The statement also provides estimates of the member’s IMRF benefits: 

Retirement benefit (if the member has at least 12 months of service credit) and the cost to purchase an 

annuity that would equal the amount of lifetime pension payments that include the annual increase, 13 th 

payments and a surviving spouse pension. 

Disability benefit 



Death benefit 

Separation refund (if the member is not vested) 

Also, if a member’s IMRF record indicates that he or she has service credit in a reciprocal retirement system, the 

statement provides the name of the system(s) and the years and months of service reported by the system(s). 

These statements are mailed directly to members who remained in participating employment through December 31 

of the preceding calendar year. Statements are also issued to inactive members. 

Members do not need to wait for an annual Personal Statement of Benefits to review their service and 

contributions. Members can review their IMRF record at anytime via the secure Member Access area of the IMRF 

website, www.imrf.org. 

6.50 B. Employer Report of Annual Personal Statements of Benefits (Exhibit 6B) 

Employers will be advised when their Employer Report of Annual Member Statements is available online via their 

Employer Access account. (Employers that do not have Internet access will receive paper copies of their employer 

reports.) Employers can view their copies of Personal Statements of Benefits via the Document Archive of 

Employer Access. 

The employer report includes a summary of the member’s service credit, and reported wages and contributions for 

the statement year. The employer report also includes a detailed breakdown of the member’s plan and tier, service 

credit, wages and contributions reported, and the type of wages, e.g., tax-deferred, disability, seasonal, etc for the 

statement year. For members of the revised Elected County Official (ECO) plan, the employer report will also 

include the member’s ECO-eligible position. 

Employer reports provide the Service Fraction for each month of service. The Service Fraction illustrates the years 

and months of service credit charged to the employer’s account. Although whole months appear on a member’s 

statement, the exact amount of months (e.g., 2.498 for 2 years 6 months) is stored in our computer system. When a 

member retires, the employer’s account is charged for the exact number of months, including a “fraction” of a 

month if a member has concurrent service. 

6.60 Discretionary Resolutions (Local Policies) 

6.60 A. To Allow UNLIMITED Service Credit for Military Leave that INTERRUPTED IMRF Participation 

(Form 6.62, Exhibit 6CC) 

Governmental units may elect to allow IMRF service credit to members who leave IMRF employment to serve in 

the armed forces of the United States for all periods of such service. Under this resolution, the service credit cannot 

be limited to a specific IMRF member and applies to all members who return to active employment under IMRF 

within 90 days after separation from the armed forces of the United States. 

Under this resolution, the military leave time, and therefore the amount of IMRF service credit a member is entitled 

to receive, is not limited. However, the member may not use the service in the computation of a pension or 

retirement pay from the U.S. government. 

6.60 B. To Allow LIMITED Service Credit for Military Leave that INTERRUPTED IMRF Participation 

(Form 6.62A, Exhibit 6DD) 

Governmental units may elect to allow IMRF service credit to members who leave IMRF employment to serve in 

the armed forces of the United States for limited periods of such service. Under this resolution, the service credit 

cannot be limited to a specific IMRF member and applies to all members who return to active employment under 

IMRF within 90 days after separation from the armed forces of the United States. 

Under this resolution, the governmental unit may limit military leave time, and therefore the amount of IMRF 

service credit a member is entitled to receive. The military leave period may be limited to a specific period of time, 




such as, two years, three years, five years, or it may be unlimited. However, the member may not use the service in 

the computation of a pension or retirement pay from the U.S. government. 

6.60 C. To Allow Service Credit for Military Service PRIOR to IMRF Participation OR for Members 

Who Do Not Return to IMRF Participation within 90 Days (Form 63A, Exhibit 6EE) 

Governmental units may elect to allow IMRF service credit to members who served in the armed forces of the 

United States prior to their participation in IMRF or whose participation was interrupted by military leave but did 

not return to IMRF participation within 90 days of discharge. 

Under this resolution, the service credit cannot be limited to a specific IMRF member and applies to all employees 

who were in active participating status under IMRF on the date this resolution was adopted. Eligible members may 

purchase up to four years of service. 

Public Act 95-0486 increased the number of years of military service an IMRF member can convert to IMRF 

service credit from two years to four. An employer’s governing body is not required to pass a new resolution 

(IMRF Form 63A) increasing the eligible military service to four years. 

If the employer’s governing body previously adopted a resolution (IMRF Form 6.63) making its IMRF members 

eligible to convert two years of military service, its members remain eligible to convert up to two years of military 

service to IMRF service. 

If the employer wants to increase the amount of military service its members can convert to IMRF service from two 

years to four years, it would need to pass a new resolution (IMRF Form 63A). 

If the employer’s governing body never adopted a resolution but wishes to do so now, it would adopt IMRF Form 

63A. Its IMRF members would be eligible to convert up to four years of military service to IMRF service. If 

desired, an employer can revoke the authorizing resolution at a later date. Employers may also pass the authorizing 

resolution again at a later date. There is no limit on the number of times an employer may pass and revoke this 

resolution. 

6.60 D. Relating to Participation by Elected Officials in IMRF (Form 6.64, Exhibit 6FF) 

Elected officials (and city hospital workers) have the option of participating in IMRF. For an elected official to 

participate in IMRF, his or her governing body must submit a resolution confirming that the elected official’s 

position meets the governmental unit’s hourly standard (600 or 1,000 hours a year), and be prepared to document 

the time actually required to perform the duties of the office (Exhibit 6FF). 

Refer to Paragraph 3.65 E. Elected Officials for more information. 

6.60 E. Adoption of the 1,000 Hour Standard (Form 6.68, Exhibit 6GG) 

Governmental units (except school districts, and special education cooperatives) may, at their option, change from 

the 600-hour annual standard to a 1,000-hour annual standard by adopting and filing resolution Form 6.68, 

“Resolution - Adoption of the 1,000 Hour Standard for IMRF Participation.” (The 1,000-hour standard did not exist 

before January 1, 1982.) If the 1,000-hour annual standard is adopted, it cannot be revoked. 

The 1,000 hour annual standard for IMRF covered positions must be applied to all positions within that 

governmental unit, including elected officials. 

If an employer changes its hourly standard from 600 to 1,000, any member who participated under that employer 

before it changed its hourly standard remains grandfathered under 600 hours. The member participates in IMRF 

under that employer if the position requires 600 hours or more, even if the employer now has a 1,000-hour 

standard. 



6.60 F. To Include Compensation Paid Under an Internal Revenue Code Section 125 Plan as IMRF 

Earnings (Form 6.72, Exhibit 6II) 

Section 125 cafeteria plans may be established under Section 125 of the Internal Revenue Code. Most options 

under a cafeteria plan are not reportable as IMRF earnings. If there is a cash option, it is IMRF earnings and must 

be reported to IMRF, unless the cash equals the employer’s cost for health insurance. ny employer may elect to 

include compensation paid under a cafeteria plan by adopting a governing body resolution (IMRF Form 6.72, 

“Resolution - To Include Compensation Paid Under an IRC Section 125 Plan as IMRF Earnings”). If such a 

resolution is adopted, most options under a cafeteria plan will be considered IMRF earnings and must be reported 

to IMRF. 

Compensation directed into a premium conversion plan or flexible spending account is not IMRF earnings unless 

the employer elects to include it in earnings by governing body resolution (IMRF Form 6.72). 

These resolutions, when adopted, may not be changed or revoked for current employees but only for new hires. 

For more information on what is considered IMRF earnings, refer to Section 3, Part 3. 

6.60 G. To Include Compensation Directed into a Retirement Health Savings Plan (Form 6.73, Exhibit 

6JJ) 

Retirement health savings plans are employer-sponsored health benefit savings vehicles that allow pre-tax savings 

for the cost of medical expenses (health insurance premiums, co-pays, prescription costs, etc.) after retirement. 

These plans are funded in a variety of ways. 

Compensation directed into a retirement health savings plan is not included as IMRF earnings, and therefore not 

reportable to IMRF, unless the employer’s governing body adopts a resolution making that compensation 

reportable. 

If the employer wants to report to IMRF the compensation directed into the retirement health savings plan, its 

governing body would adopt a resolution, IMRF Form 6.73, “Resolution - To Include Compensation Paid Under a 

Retirement Health Savings Plan as IMRF Earnings.” 

For more information on what is considered IMRF earnings, refer to Section 3, Part 3. 

6.60 H. To Adopt IMRF Early Retirement Incentive (Form 6.77, Exhibit 6KK) 

If a unit of government is considering adopting the IMRF Early Retirement Incentive (ERI), its governing body 

would pass a resolution or ordinance adopting the ERI after reviewing the actuarial cost estimate prepared by 

IMRF. This cost estimate is mandatory. The ERI would be available for one year from the program effective date. 

If an IMRF employer adopts the program, the ERI applies to all eligible IMRF members, regardless of the position 

held or length of service with the unit of government. The ERI would also apply to elected officials participating in 

IMRF. Refer to Paragraph 5.20 C. IMRF Early Retirement Incentive (ERI) for more information. 

Limitations on Successive ERI Windows 

Effective with ERI windows opened on or after December 31, 2013, another window may not be adopted for five 

years after the close of the previous window. 

Dissolving employers 

If an employer is aware—or has reason to be aware—of its future dissolution under state law, and its IMRF assets 

and liabilities will be transferred to: 

One successor unit of government 

The dissolving employer must provide the ERI Cost Study to the successor, and the successor must also approve 

the ERI. A copy of the successor unit’s resolution approving the ERI must be available to IMRF upon request. 




More than one successor unit of government 

The dissolving employer must provide the ERI Cost Study to each successor, and a majority of the successors must 

approve the ERI. Copies of the successor units’ resolutions approving the ERI must be available to IMRF upon 

request. 

No successor unit of government and the law does not specify responsibility for the IMRF assets 

and obligations 

The IMRF Board of Trustees must approve the ERI. 

IMRF will not implement an ERI that does not conform to these requirements. If IMRF discovers that these 

requirements were not met after paying an ERI enhanced pension to a member who retired under ERI: 

 

 

The member will lose the ERI enhancements and be required to pay IMRF the difference between the ERI 

enhanced pension and the pension he or she would have received without the ERI—less the amount the 

member paid for the ERI. 

In addition, if the member was less than the minimum retirement age (age 50 for SLEP, age 55 for Regular 

Tier 1 and ECO Tier 1, age 62 for Regular Tier 2 ), the member will be required to repay IMRF for all 

pension payments received that he or she was not eligible for—less the amount the member paid for the ERI. 

6.60 I. To Adopt Amortization Period for IMRF Early Retirement Incentive (Form 6.78, Exhibit 6LL) 

Once a unit of government adopts the IMRF Early Retirement Incentive (ERI), an amortization period of 10 years 

(to pay the employer costs) is assumed. 

If an employer would like an amortization period of less than 10 years, it would submit IMRF Form 6.78, 

“Resolution - To Adopt Amortization Period,” doing so. 

Refer to Paragraph 5.20 C. IMRF Early Retirement Incentive (ERI) for more information on the IMRF ERI or to 

Paragraph 7.23 Financing the Cost of IMRF Early Retirement Incentive (ERI) for information on financing ERI 

pensions. 

6.60 J. To Authorize Pension Service Credit for Employees Previously Barred by Age (Form 6.79, 

Exhibit 6MM) 

Form 6.79, Suggested Resolution to Authorize Pension Service Credit for Employees Previously Barred by Age, 

has been discontinued. 

6.60 K. To Adopt Alternative Benefit Program for County Officers (ECO) 

The Elected County Official (ECO) Plan is closed to new members as of August 8, 2011. Counties may no longer 

adopt the ECO plan. 

6.60 M. For Employer Pick-Up (Payment) of Member Contributions Required for Purchase of Extra 

Service Under the IMRF ERI (Form 6.85, Exhibit 6RR) 

If a unit of government adopts the IMRF Early Retirement Incentive (ERI), the unit may also choose to pay the 

member cost for the ERI. However, that payment will be taxable to the member unless the governing body passes a 

resolution (IMRF Form 6.85, “Resolution - For Employer Pick Up of Member Contributions”) specifically stating 

that the contributions are being made in lieu of the member’s contributions and that the member is prohibited from 

receiving any part of those contributions. 

IMRF is not suggesting that an employer pay the member’s ERI costs. This information is provided in the event 

such action is considered. If the employer does not pass the “pick-up” resolution, the employer payment of the 

member’s ERI contributions will be taxable income to the member in the year it is paid and must be included on 

the member’s W-2. 



If the pick-up resolution is passed, the payment will not be taxable when paid. In either case, the payment is not 

considered IMRF earnings or Social Security wages. 

PLEASE NOTE: employer cost savings, which would result from adopting the ERI, will be reduced significantly 

if an employer pays the member cost. 

6.60 N. To Adopt the IMRF Sheriff’s Law Enforcement Personnel Program for Airport Police (Form 

1.55, Exhibit 6SS) 

An airport authority may elect to allow its airport police to become SLEP by having its governing board adopt an 

irrevocable resolution (Form 1.55) authorizing its airport police to be reported as SLEP members. 

There is no requirement that an airport authority allow its police officers to join SLEP. However, once the SLEP 

plan has been adopted for airport police, it cannot be rescinded. 

The airport police officers would join IMRF SLEP prospectively. Airport police joining SLEP will retain their 

Regular IMRF service credit and start with no credit towards a SLEP pension. As SLEP members, the police 

officers would be eligible to convert up to 10 years of Regular plan service credit to SLEP if enrolled before 

August 8, 2011. Members who join the SLEP plan on or after August 8, 2011 are not eligible to upgrade Regular 

service credit to SLEP. 

If the resolution is adopted, the following airport police officers would participate in IMRF SLEP: 

1. Airport police officers not eligible to participate in a local police pension plan, and 

2. Officers performing police duties at an airport on a full-time basis. 

Airport police working less than full-time will remain Regular IMRF members 

SLEP participation would begin on the date specified in the resolution. For the first two years, the employer rate for 

SLEP participants will be based on the normal cost for the SLEP program plus death and disability contributions as 

well as supplemental benefit contributions. The rates can be found in IMRF’s Annual Financial Report. 

6.60 O. To Include Taxable Expense Allowances as IMRF Earnings (Form 6.74, Exhibit 6XX) 

Expense allowances are not included as IMRF earnings, and therefore not reportable to IMRF. However, an 

employer may elect to include taxable expense allowances in IMRF reportable earnings. The governing body must 

adopt a resolution to include taxable expense allowances as IMRF earnings by adopting a resolution (Form 6.74, 

Exhibit 6XX). 

Non-taxable expense reimbursements are not included as earnings and are not to be reported to IMRF. This is true 

even if an employer elects to make taxable expense allowances reportable. 

6.60 P. To Adopt the IMRF Sheriff’s Law Enforcement Personnel Program for a Forest Preserve 

District (Form 1.56, Exhibit 6AAA) 

A Forest Preserve District may elect to allow its personnel to become SLEP by having its governing board adopt an 

irrevocable resolution (Form 1.56) authorizing its law enforcement officers to be reported as SLEP members. 

There is no requirement that a Forest Preserve District allow its law enforcement officers to join SLEP. However, 

once the SLEP plan has been adopted for Forest Preserve District law enforcement officers, it cannot be rescinded. 

The Forest Preserve District law enforcement officers would join IMRF SLEP prospectively. The officers joining 

SLEP will retain their Regular IMRF service credit and start with no credit towards a SLEP pension. 

If any of the officers participated in SLEP with another employer before August 8, 2011, he or she would be 

eligible to convert up to 10 years of Regular Plan service to SLEP. 




If the resolution is adopted, the following Forest Preserve District law enforcement officers would participate in 

IMRF SLEP: 

1. Forest Preserve District law enforcement officers not eligible to participate in a local pension plan, and 

2. Officers performing police duties for a forest preserve district on a full-time basis 

Forest Preserve District law enforcement officers working less than full-time will remain Regular IMRF members 

SLEP participation would begin on the date specified in the resolution. For the first two years, the employer rate for 

SLEP participants will be based on the normal cost for the SLEP program plus death and disability contributions as 

well as supplemental benefit contributions. The rates can be found in IMRF’s Annual Financial Report. 

6.70 Account Adjustment Appeal Rights 

See Section 5, paragraph 5.70 Appeal procedure for denied claims - non-disability. 

IMRF’s complete Appeal Procedures are available online at www.imrf.org/info/appeals/appeals_procedures.htm. 


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Exhibit 6B


Exhibit 6 C 

Statement has been DISCONTINUED


Request For Rollover Approval for Past Service 

IMRF Form 6.01 (Rev. 06/12) 

Exhibit 6D 

Page 1 of 2 

Do not withdraw any funds 

or send any rollover distributions to IMRF 

before we advise you of your eligibility to do so. 

IMRF must review your rollover information before we can accept a rollover. 

Please allow at least 10 days for this review. 

For rollover for ERI (Early Retirement Incentive), please use form 6.01E, instead of this form. 

1. Do NOT send money with this form 

Before IMRF can accept any rollover monies, specific 

information must be submitted to IMRF for an eligibility 

review. 

2. What you and your financial institution must do 

Your financial institution must provide ALL information 

required on the form. The institution completes Section 2 of 

the Rollover Certification form. Be sure to: 

• check what type of account the rollover is coming from. 

• indicate what amount is tax deferred. 

• indicate what amount is previously taxed. 

3. Rollover distributions we CANNOT accept 

The Internal Revenue Code (IRC) regulations do not permit 

us to accept a rollover distribution from: 

• any rollover funds greater than the total 

cost of your past service. The maximum amount we 

can accept cannot exceed the total due on your payment 

schedule(s) 

• a Roth IRA 

• previously taxed money in a traditional IRA 

4. Rollover distributions we CAN accept 

Federal tax laws allow IMRF to accept rollover distributions 

for payment of past service in certain circumstances. The 

rollover must be from: 

• another qualified pension plan (for example, an out-ofstate 

public retirement system) OR 

• a traditional IRA OR 

• an IRC section 457 plan OR 

• an IRC section 403(b) plan 

5. When your rollover request is approved 

When IMRF contacts you (either by phone or letter) and 

advises you that we can accept the rollover funds as a taxdeferred 

payment, you are responsible for contacting your 

financial institution to arrange the transfer. IMRF cannot 

direct your financial institution to process the transfer — the 

request must come from you as a holder of the account. 

6. If you send an ineligible distribution to IMRF 

If you send a rollover distribution to IMRF that federal tax 

laws do not allow us to accept, the rollover distribution will 

be returned either to you or to your financial institution. 

7. If your rollover is from a traditional IRA, the financial 

institution may not know what amount is tax deferred. In 

that case, please submit a letter in which you certify what 

portion of the money in the account is tax deferred and 

what portion is previously taxed. Please make sure you sign 

and date the letter and that it includes your Social Security 

number. Without a certification from either the financial 

institution or from the above letter, we will not be able to 

approve your rollover request. 

8. You may roll over monies ONLY from accounts in 

your name. Monies from an account where you are a 

named beneficiary do NOT qualify as a rollover under 

IRS rules. 

If you have any questions: 

call an IMRF Member Services Representative at 

1-800-ASK-IMRF (1-800-275-4673) Monday through Friday 7:30 A.M. to 5:30 P.M. — Fax (630) 706-4289 


www.imrf.org

Request For Rollover Approval for Past Service 

IMRF Form 6.01 (Rev. 06/12) PLEASE PRINT OR TYPE — USE BLACK INK 

Exhibit 6D 

Page 2 of 2 

Avoid delays—read the instructions before completing this form 

• Do not withdraw any funds or send any rollover distributions to IMRF before we advise you of your eligibility 

to do so. 

• Complete this certification to roll over tax-deferred distributions from another qualified plan or qualifying individual retirement 

account (IRA) for payment of past service credit. 

• If your rollover is for ERI (Early Retirement Incentive), please use Form 6.01E instead of this form. 

SECTION 1 — MEMBER INFORMATION 

MEMBER’S FIRST NAME MIDDLE INITIAL LAST JR., SR., II, ETC. SOCIAL SECURITY NUMBER 

Mary A. Member 000 00 0000 

STREET (MAILING ADDRESS) CITY STATE ZIP +4 

123 Elm Street Anywhere, IL 60000 

MEMBER’S TELEPHONE NUMBERS 

WORK ( 000 ) 000 - 0000 HOME ( 000 ) 000 - 0000 

SECTION 2 — CERTIFICATION BY FINANCIAL INSTITUTION 

NAME AND ADDRESS OF PLAN/FINANCIAL INSTITUTION 

NAME ON ACCOUNT 

First National Bank of Anywhere 

Mary A. Member 

300 Main Street 

ACCOUNT NUMBER 

Anywhere, IL 60000 123-45-0 

The qualified plan or individual retirement account named above is (check one) 

X 

________________ - ________ - ________________ 

TELEPHONE NUMBER (include area code) 

( 000 ) 000 - 0000 

A retirement plan under Internal Revenue Code Section (circle which one) 401, 457, 403b, other (specify) __________ 

An individual retirement account (“IRA”) (Not a ROTH IRA) 

WHAT AMOUNT IS TAX DEFERRED 

$2,378.22 

WHAT AMOUNT, IF ANY, WAS PREVIOUSLY TAXED (CANNOT COME FROM AN IRA) 

SIGNATURE OF AUTHORIZED OFFICIAL OF FINANCIAL INSTITUTION (NOT EMPLOYER) WRITE - DO NOT PRINT OR TYPE 

DATE (MM/DD/YY) 

August 18, 2007 

PRINTED NAME OF AUTHORIZED OFFICIAL OF FINANCIAL INSTITUTION 

SECTION 3 — MEMBER CERTIFICATION 

I request that IMRF accept a rollover distribution in the amount of $______________ from the institution named above. 

(IMRF CANNOT ACCEPT AN AMOUNT LARGER THAN THE COST TO PURCHASE THE PAST SERVICE) 

With this distribution I am purchasing _____________ months of IMRF Past Service Credit. (Check type of Past Service below.) 

Military Service Omitted Service Prior Service SLEP Conversion 

Reinstated Service Retroactive Service Out-of-State Service 

I understand that I may be required to provide proof, if requested, in support of the above statements. I also understand 

that my rollover must be made to IMRF within 60 days of receipt of the distribution. I agree with the information provided 

by my financial institution. 

Member Signature (write - do not print or type) 

X 

Sandra Smith 

X 

19 

2,378.22 

ALL QUESTIONS MUST BE ANSWERED BEFORE SUBMITTING FORM TO IMRF 

Completed form may be mailed to: Illinois Municipal Retirement Fund 

Suite 500 2211 York Road Oak Brook IL 60523-2337 

Member Services Representatives 1-800-ASK-IMRF (1-800-275-4673) — Fax (630) 706-4289 


www.imrf.org 

TITLE 

Date 

Bank Administrator 

August 18, 2007

Application for Military Service Credit 

IMRF Form 6.02J (Rev. 9/2007) 

Exhibit 6E 

Page 1 of 2 

If you have any questions, call 1-800-ASK-IMRF (1-800-275-4673) 

• The purchase of military service for public employees is a benefit designed to partially compensate veterans for their service in the armed forces. 

• Any converted military service credit is applied toward the calculation of a member’s IMRF benefits. 

• Member cost and other requirements differ under each law. Please read the following information carefully to determine if you are 

eligible to establish military service credit under one of the following laws. 

• If member contributions and interest are required, IMRF will mail you a payment schedule after your application is received and your 

cost is calculated. 

• Establishing service as Elected County Official (ECO) Service: To establish ECO service, the member must have previously participated, or 

be currently participating, in IMRF under the ECO plan. The member must also have IMRF Form 6.21B, “Election to Contribute under the 

ECO Plan” on file with IMRF, and the county under which the member opted to participate in ECO must have a standing resolution on file 

allowing such participation. (NOTE: Only members under the Original ECO plan may establish military service credit as ECO service. 

Members of the Revised ECO plan may convert their military service credit only to Regular service credit.) 

• When submitting this form, you should also request formal pension estimates with and without the additional service credit by submitting 

IMRF Form BF-20, “Pension Estimate Request.” Request Form BF-20 by calling 1-800-ASK-IMRF (1-800-275-4673) or by downloading the 

form from www.imrf.org. You can also request a Formal Pension Estimate through your IMRF Member Access account. 

UNDER ILLINOIS LAW 

UNDER FEDERAL LAW 

MILITARY SERVICE EARNED BEFORE 

IMRF PARTICIPATION OR DID NOT 

RETURN TO IMRF WITHIN 90 DAYS 

MILITARY LEAVE INTERRUPTED 

MILITARY LEAVE INTERRUPTED 

IMRF PARTICIPATION AND RETURNED 

TO IMRF WITHIN 90 DAYS 

IMRF PARTICIPATION AND 

RETURNED TO SAME EMPLOYER 

Member participation 

as related to military leave 

Military leave can have occurred 

at any time, even prior to first 

date of participation in IMRF. 

Must have participated in IMRF 

before and after military leave; 

can participate with different 

IMRF employers. Must return to 

IMRF participating employment 

within 90 days of discharge. 

Must participate in IMRF before 

and after military leave with the 

same IMRF employer. Return to 

work requirement varies. 

Member’s current 

participation 

Must be currently participating 

in IMRF. 

Must be participating in IMRF or 

in another retirement system 

covered by the Reciprocal Act. 

Must be participating in IMRF or 

in another retirement system 

covered by the Reciprocal Act. 

Member cost 

If member has cost, IMRF will 

calculate your cost and send you 

a payment schedule. You may 

purchase the service credit in a 

lump sum or on a payment plan. 

Member and “normal” employer 

contributions plus interest 

calculated from first date of 

participation in IMRF. Salary 

used to calculate cost is first 

salary earned as IMRF member. 

Free 

Member contributions plus interest 

calculated from the end of the 

military leave period. Salary 

used to calculate cost is the 

salary in effect when the military 

leave began. 

Maximum number of years 

member can purchase 

Two or four years, determined 

by employer resolution 

No maximum, but employer may 

limit by resolution. 

Five years. 

Military documentation 

A copy of release order 

or military discharge must 

accompany this form. 







Military pension 

May still use the service in the 

computation of a pension or 

retirement pay from the U.S. 

government. 

May not use the service in the 



government. 

May still use the service in the 



government. 

Employer resolution 

required 

Yes, covers all IMRF members 

under that employer. 

Yes, covers all IMRF members 

under that employer. 

No. 

Employer cost 

Through future employer rates. 



IMRF Form 6.02J (Rev 9/2007)

Application for Military Service Credit 


PLEASE PRINT OR TYPE — USE BLACK INK 

Exhibit 6E 

Page 2 of 2 


James M. Rowe 

__ __ __ __ __ __ __ __ __ 

STREET ADDRESS CITY STATE ZIP TELEPHONE NUMBER + AREA CODE 

123 Elm Street Anywhere IL 60000 

0 0 0 - 0 1 - 1 1 1 1 

630-555-1111 

CURRENT EMPLOYMENT INFORMATION 

NAME OF CURRENT EMPLOYER 

City of Anywhere 

NAME OF CURRENT RETIREMENT SYSTEM 

IMRF 

OPTIONAL: ANTICIPATED RETIREMENT DATE 

IMRF COVERAGE INFORMATION 

IF YOU PREVIOUSLY USED A DIFFERENT NAME, PLEASE INDICATE 

DATE OF BIRTH 

LIST ALL FORMER IMRF EMPLOYERS PERIOD OF EMPLOYMENT (E.G. 9/87 - 3/96) 

CHECK ONE (Refer to instructions on previous page) 

I am converting my military service to IMRF service credit under the following designation: 

Military leave prior to IMRF participation OR leave interrupted IMRF participation, but did not return within 90 days of discharge and/or the 

employer has not adopted 6.62 resolution 

■x 

Illinois law: Service credit during military leave as provided by Public Acts 90-0488 and 95-0486. 

Employer has filed resolution (IMRF Form 6.63 or 6.63A) with IMRF. 

Military leave interrupted IMRF participation 

■ Illinois law: Service credit during military leave as provided by the Illinois Pension Code. 

Employer has filed resolution (IMRF Form 6.62 or 6.62A) with IMRF. Converting military service under the provisions of the Illinois 

Pension Code, means that this service will not be used in the computation of a pension or retirement pay from any branch of 

the Armed Forces of the United States. 

■ 

Federal law: Service credit during military leave as provided by the Uniformed Services Employment and Re-employment Rights Act. 

No employer resolution required. 

CERTIFICATION BY MEMBER 

I certify that I entered the Armed Forces of the United States on 

June 11, 1986 

June 10, 1984 

DATE 

October 18, 1990 

and I completed 

duty on . I began IMRF participation on . 

DATE 

I have attached documentation from the military attesting to the validity of the dates of my military service. 

Choose one: 

I wish to establish the service on this application as: 

See instructions for eligibility of ECO or SLEP plan. 

x 

■ Regular Service 

■ Elected County Official Service—ECO (See instructions on page 1) 

■ SLEP Service (limitations may apply) 

■ 

I have requested pension estimates with and without the additional service credit I intend to purchase (see instructions). 

Member’s Signature __________________________________________ 

November 3, 2007 

Date _________________________________________ 

FOR USE BY IMRF 

CALCULATED AUDITED SJE CODE SERVICE GRANTED 

USE BY 



2211 York Road, Suite 500, Oak Brook Illinois 60523-2337 

1-800-ASK-IMRF (1-800-275-4673) 

www.imrf.org

Application for Reinstatement of Service Credit 

(Repaying a Refund) 


Exhibit 6F 

Page 1 of 3 

Avoid delays—read the instructions below and on back before completing this form 

Requirements for reinstatement of service credit 

If you have received an IMRF separation refund and have 

forfeited your IMRF pension credits (service), you may 

have those credits restored provided you meet all of the 

following: 

A. Your application is received by IMRF while you are 

currently participating in IMRF or another retirement 

system covered by the Illinois Retirement Systems 

Reciprocal Act. “Currently participating” means that 

you are employed in a position covered under one of 

the systems. It does not include individuals who are 

retired. 

B. If you participate in IMRF’s Regular or ECO plan, you 

have completed two or more years of contributing 

service under IMRF or another retirement system 

covered by the Illinois Retirement Systems Reciprocal 

Act following the date of your last refund. If you 

currently participate in IMRF’s SLEP plan, you can 

repay the refund after you have completed 1,000 

hours of contributing IMRF service under SLEP. 

C. You complete this form and mail it to IMRF. 

D. You repay the refund and pay interest on it from the 

date of the refund. 

Instructions for completing this form 

1. Member information 

Enter the requested information, including a daytime 

telephone number. 

2. Retirement system information 

Check the system you currently participate in, enter 

the date you joined that system, and the name of your 

current employer. Optional: enter your anticipated 

retirement date. 

3. Forfeited/refunded IMRF coverage 

If you separated from more than one governmental unit 

(more than one employer), show all of the governmental 

units (employers) you worked for and each year that you 

received a separation refund check from IMRF. You are 

not required to reinstate all refunded service (to pay 

back all of your refunds). However, you must list all 

refunds you received. 

4. Elected County Official plan 

In order to establish service as Elected County Official 

(ECO) service, you must have previously participated 

in or be currently participating in IMRF under the ECO 

plan. In addition, you must have IMRF Form 6.21B, 

“Election to Contribute under the ECO Plan,” on file 

with our office and the county under which you opted to 

participate under the ECO plan must have a standing 

resolution on file allowing such participation. 

5. Member certification 

Sign and date where indicated. 

6. Options for completing Form 6.03: 

• eFORM — You may submit Form 6.03 online by 

signing into your IMRF Member Access account and 

selecting “Secure Online Forms” under the “Tools” 

tab. To create a Member Access account, visit 

www.imrf.org/myimrf. 

• Enterable PDF — You may enter information into the 

PDF form 6.03 at www.imrf.org. Print, sign, and mail 

or fax the form to IMRF (contact information below). 

• Paper form — You may request a paper form be 

mailed to you by calling 1-800-ASK-IMRF 

(1-800-275-4673). 

• IMRF Member Services Representative — You may 

have a Member Services Representative complete 

the form for you by calling 1-800-ASK-IMRF 

(1-800-275-4673). 


2211 York Road Suite 500 Oak Brook Illinois 60523-2337 

Member Services Representatives 800/ASK-IMRF (1-800-275-4673) Fax (630) 706-4289 


www.imrf.org

IMRF will mail you a Past Service Payment Schedule 

which offers two payment plan options for establishing 

the past service: 

Option I - Lump Sum Payment Plan 

The Lump Sum Payment Plan allows you to pay the 

total cost with a single pay ment and purchase all of 

the eligible service you choose to. You can purchase 

a portion, all, or none of the past service listed on the 

payment schedule. 

How do you repay the refund to IMRF 

Do you want to use funds from an IRA or another pension plan to pay back the refund 

Exhibit 6F 

Page 2 of 3 

Option 2 - Unit Payment Plan 

The Unit Payment Plan allows you to purchase one 

or more months of service credit at a time. You may 

pay as often as you like, buying back credit from 

the latest month to the earliest month of eligible 

service. However, you may not buy more months than 

indicated on the Past Service Payment Schedule. 

In addition, after you terminate IMRF or recriprocal 

participating employment, you may make only one 

final payment to purchase your IMRF service. 

You may pay for forfeited service with a qualified pension plan as defined by Section 401a, 457, 403b, etc. of the 

Internal Revenue Code or traditional individual retirement account (IRA). 

Please complete and submit IMRF Form 6.01, “Request for Rollover Approval,” for determination of eligibility. 

How repaying the refund will affect your future pension 

If you want to know how the reinstated service will affect 

your pension, you should wait until you receive the Past 

Service Payment Schedule. Then, you can request a formal 

pension estimate by calling 1-800-ASK-IMRF 

(1-800-275-4673) or at www.imrf.org through your secure 

Member Access account. If you are participating in a 

reciprocal system, you should contact your current system 

for an estimate. 

You can also refer to the IMRF Past Service Booklet, 

which can be found online at www.imrf.org, or by calling 

1-800-ASK-IMRF. The section titled “Is it worth it to 

purchase service” provides a detailed description of how 

to calculate the impact of service on a pension. 

If you retire under the Reciprocal Act 

The Illinois Retirement Systems Reciprocal Act requires 

a minimum of 12 months (one year) of service credit with 

any single reciprocal pension system. If you have less than 

12 months of service in a reciprocal retirement system, 

that service will not be counted in the calculation of your 

reciprocal pension. 

Exception: A former teacher aide who transferred to a 

position covered by the Teachers’ Retirement system (TRS) 

and who has less than 12 months of IMRF service credit 

can apply that service toward a reciprocal pension. 

The 13 systems covered by the Act are listed in Section 5 

of the IMRF Manual for Authorized Agents and on the IMRF 

website, www.imrf.org. Local police and fire pension funds 

are not covered by the Act. 

IMRF Form 6.03 (Rev. 01/2013)

Exhibit 6F 

Page 3 of 3 

Application for Reinstatement of Service Credit (Repaying a Refund) 


NOTE: You may also submit Form 6.03 online via IMRF Member Access. 

Log on to www.imrf.org/myimrf to create your IMRF Member Access account today. 


__ __ __ __ __ __ __ __ __ 

___________________ - __________ - __________________ 

STREET (MAILING) ADDRESS CITY STATE ZIP + 4 DAYTIME TELEPHONE NO. (with Area Code) 

123 Elm Street Anywhere, IL 60000 ( 0 0 0 ) 0 0 0 - 0 0 0 0 

INDICATE SYSTEM/FUND YOU ARE CURRENTLY PARTICIPATING UNDER: 

X 

Illinois Municipal Retirement Fund State Employees’ Retirement System State Teachers’ Retirement System 

State Universities Retirement System Judges’ Retirement System Cook County Annuity & Benefit Fund 

General Assembly Retirement System Chicago Public School Teachers’ Cook County Forest Prsv. Ann. & Bnft. Fund 

Laborers’ Annuity & Benefit Fund Municipal Employees Ann. & Bnft. Fund Park Employees’ Annuity & Benefit Fund 

Metro Water Reclam. Ret. Sys. (Chgo. San. Emp. Tr.) 

PLEASE PRINT 

James L. Smith 0 0 0 0 0 0 0 0 0 

DATE PARTICIPATION BEGAN IN CURRENT SYSTEM (MM/DD/YYYY) 

06/02/2006 

CURRENT EMPLOYER 


OPTIONAL: ANTICIPATED RETIREMENT DATE (MM/DD/YYYY) 

FORFEITED/REFUNDED IMRF COVERAGE INFORMATION 

IF YOU PREVIOUSLY USED A DIFFERENT 

DATE OF BIRTH (MM/DD/YYYY) 

NAME WITH IMRF, PLEASE INDICATE: 

LIST ALL IMRF EMPLOYERS FOR WHICH YOU 

YEAR RECEIVED 

WERE COVERED AND RECEIVED A REFUND CHECK COVERAGE PERIOD SEPARATION REFUND CHECK 

CERTIFICATION BY MEMBER: 

I hereby certify that 

• I have re-entered public employment with a governmental employer participating under the Illinois Municipal 

Retirement Fund or under another retirement system covered by the Illinois Retirement Systems Reciprocal Act, and 

• If I participate in the IMRF Regular or ECO plan, I have rendered two or more years of service since I re-entered public 

employment and have contributed for that time to the retirement system indicated above, and 

• I now request you to advise me of the payment required to reinstate the service credits I accumulated under the Illinois 

Municipal Retirement Fund and forfeited by acceptance of a separation refund. 

Choose one: 

I wish to establish the service on this application as: 

X 

Regular Service 

Elected County Official Service—ECO (see instructions for eligibility) 

SLEP Service (limitations may apply) 

x 

Signature of Member 

Date (MM/DD/YYYY) 

06/14/2013 



Member Services Representatives 800/ASK-IMRF (1-800-275-4673) Fax (630) 706-4289 


www.imrf.org


APPLICATION FOR RETROACTIVE SERVICE CREDIT 


Avoid delays—read the instructions below and on the back before completing this form 

1. The application must be received by IMRF while the 

member is currently participating in IMRF or another 

retirement system covered by the Illinois Retirement 

Systems Reciprocal Act. 

2. The member earned the service after the date the 

governmental unit (employer) joined IMRF. If the member 

earned the service before the employer joined IMRF, use 

Form 6.07, “Application for Prior Service Credit.” 

3. The member earned the service in a position which 

qualified him or her for membership in IMRF. 

4. This form is certified by the IMRF Authorized Agent and 

by the member. 

5. The member pays IMRF contributions on the earnings 

and interest from the end of the retroactive period. 

6. The member falls into one of the following categories: 

a. County Elected Officials who worked in qualifying 

positions as affirmed in a resolution adopted by the 

County Board (IMRF Form 6.64). Limited to a 

50-month maximum, unless he or she is a member of 

the County Board and a resolution (IMRF Form 6.81) 

was adopted before January 1, 1999 or December 

31, 2001. 

b. Non-County Elected Officials who worked in 

qualifying positions as affirmed in a resolution 

adopted by the governing body (IMRF Form 6.64). 

Limited to a 50-month maximum by the Illinois 

Pension Code unless board adopted resolution (IMRF 

Form 6.81) before December 31, 2001. 

1. Certification by Authorized Agent for Position 

Check the box that applies to the member. (See number 

6 above.) If checking “other,” specify position category on 

the line provided. 

2. The Member Earnings Chart 

a. Enter the time period of retroactive service being 

applied for (“Retroactive Period Dates”). 

b. Enter the 4-digit year in the top row of the chart for as 

many columns as you will need. If more than 7 years 

of service are being entered, please photocopy this 

form. Indicate below the chart in the provided area 

the current page number and the number of pages 

submitted (Page ___ of ___ ). 

c. Place an “x” in the earnings column if the member 

received earnings for that month. Or, if the member 

should receive Seasonal Service or Irregularly Paid 

Service, enter “SE” or “IP.” (See numbers 7 and 8 

above for SE and IP information.) 

d. If there are months the member should not receive 

service, leave them blank, or draw a line through all of 

the columns. 

e. Enter the total months of service credit earned and 

annual earnings per year. 

3. Authorized Agent Certification 


Requirements for Retroactive Service Credit 

Instructions for Completing this Form 

Exhibit 6G - Page 1 of 3 

c. City hospital employees. Limited to a 50-month 

maximum by the Illinois Pension Code. 

d. Employees of township road districts which became 

participating employers in IMRF on June 1, 1974, as 

part of a township. 

e. ROTC instructors who rendered qualifying service 

prior to October 1, 1977, the date they would qualify 

for IMRF coverage. 

f. Members who were employed between January 1, 

1956, and July 1, 1957, who were required to wait 

one year before becoming eligible to participate. 

7. If the member has periods of Seasonal Leave (SE) 

The member may receive service credit for periods 

without earnings, provided he or she: 

a. was employed in a seasonal position, and 

b. had six consecutive months of earnings within a 

12-month period, and 

c. remained in an employment relationship during the 

seasonal leave period, and received earnings after 

the leave period. If the member did not receive 

earnings after the seasonal leave period, please 

explain why, and we will determine whether service 

should be granted. 

8. If the member is Irregularly Paid (IP) 

The member may receive service credit for periods 

without earnings, provided he or she (usually an 

elected official) is normally paid annually, bi-annually, 

quarterly, etc. 

4. Selection of Service Type: 

a. Regular Plan 

The basic IMRF plan that includes all eligible 

employees working for an IMRF employer, who meet 

the hourly standard (600 or 1,000) for that employer. 

b. Elected County Official (ECO) Plan 

In order to establish service as Elected County Official 

(ECO) service, the member must have participated in 

IMRF under the ECO plan. In addition, the member 

must have IMRF Form, “Election by Elected County 

Official to Participate in IMRF Elected County Official 

Plan,” on file with our office. Refer to the ECO booklet 

appropriate to your plan (Original or Revised ECO). 

These booklets can be viewed at www.imrf.org or can 

be obtained by calling 1-800-ASK-IMRF (1-800-275- 

4673). Purchase of retroactive service will NOT 

make a Revised ECO Tier 2 Member eligible for 

Revised ECO Tier 1. 

c. Sheriff’s Law Enforcement Personnel (SLEP) Plan 

In order to establish service as SLEP service, 

the member must have been a county sheriff. 

Documentation must be submitted along with the 

application for service, verifying that the member was 

the elected sheriff. 

IMRF Form 6.04 (Rev. 11/2013) instructions continued ...


“Instructions...” continued from front 

See the IMRF Manual for Authorized Agents for more 

detailed information. 

6. Member Certification 


How the member pays for the service 

1. Member Cost 

IMRF will mail the member a Past Service Payment 

Schedule which offers two payment plan options for 

establishing the past service: 

Option I is the Lump Sum Payment Plan 

The Lump Sum Payment Plan allows members to pay 

the total cost with a single payment and purchase all 

the eligible service he or she chooses to purchase 

at one time. The member can purchase a portion, 

all, or none of the past service listed on the payment 

schedule 

Option 2 is the Unit Payment Plan 

The Unit Payment Plan allows members to purchase 

one or more months of service at a time. Members 

may pay as often as they like, buying back credit 

from the latest month to the earliest month of eligible 

service. 

2. Using funds from an IRA or another pension plan to 

purchase the service 

The member may pay for this service with a qualified 

pension plan as defined by Section 401a, 457, 403b, etc. 

of the Internal Revenue Code, or a traditional individual 

retirement account (“IRA”). The member would complete 

and submit IMRF Form 6.01, “Request for Rollover 

Approval,” for determination of eligibility. 

Income tax consequences for members 

Has the member made deductible IRA contributions 

Members who made deductible IRA contributions prior to 

1982 or after 1986 may be subject to a penalty for the IRA 

contributions made for the retroactive period. These 

members should consult the Internal Revenue Service 

directly. 

How purchasing the service will affect the member’s pension 

Members who want to know how the retroactive service will 

affect their pension should wait until they receive the Past 

Service Payment Schedule. Then they can call 

1-800-ASK IMRF (1-800-275-4673) or their current system for 

a pension estimate. 

They can also refer to the IMRF Past Service Booklet, 


1-800-ASK-IMRF. The section titled “Is it worth it to purchase 

service” provides a detailed description of how to calculate 

the impact of service on a pension. 

If the member plans to retire under the Reciprocal Act 


a minimum of 12 months of service credit with any single 

reciprocal pension system. If the member has less than 12 

months of service in a reciprocal retirement system, that 

service will not be counted in the calculation of his or her 

reciprocal pension. Exception: A former teacher aide who 

transferred to a position covered by the Teachers’ Retirement 

System (TRS) and who has less than 12 months of IMRF 

service credit can apply that service toward a reciprocal 

pension. A list of the 13 systems covered by the Act can be 

found in Section 5 of the IMRF Manual for Authorized Agents 

and on the IMRF website, www.imrf.org. Local police and fire 

pension funds are not covered by the Act. 

The employer’s contribution for retroactive service is paid 

through future contribution rates. Therefore, a separate 

employer payment is not required. The actuary will take the 

Employer’s Cost 

retroactive service into account when determining the annual 

employer contribution rate. 


APPLICATION FOR RETROACTIVE SERVICE CREDIT 


MEMBER’S LAST NAME FIRST NAME MIDDLE INITIAL JR., SR., II, ETC. SOCIAL SECURITY NUMBER 

Rowe James J. 

STREET (MAILING) ADDRESS CITY, STATE AND ZIP DAYTIME TELEPHONE NUMBER (w/Area Code) 

123 Birch Street Anywhere, IL 60000 

EMPLOYER WHERE SERVICE WAS RENDERED 


SIGNATURE OF AUTHORIZED AGENT 

Choose One: I wish to establish the service on this application as: 

DATE (MM/DD/YYYY) 

* Limited to 50 months without 6.81 resolution. ** Limited to 50 months by the Illinois Pension Code. 

# A resolution finding that the elected position qualifies for membership must be on file with IMRF. 

EMPLOPYER IMRF I.D. NUMBER 

DATE PARTICIPATION BEGAN IN CURRENT SYSTEM (MM/DD/YYYY) CURRENT POSITION 

RETROACTIVE POSITION OPTIONAL: ANTICIPATED RETIREMENT DATE (MM/DD/YYYY) DATE OF BIRTH (MM/DD/YYYY) 

CERTIFICATION BY AUTHORIZED AGENT: I certify that the following statement of earnings for the above applicant is in agreement 

with the governmental unit’s payroll records and represents the entire qualifying employment period determined by the governing body. 

I further certify that: 

• The applicant worked in a position which qualified him or her for membership in IMRF. Retroactive Period (MM/DD/YYYY): 

• The service which the applicant rendered is eligible under one of the following designations: 

q County Elected Official*# 

q City Hospital employee** 

____________ 05/01/2004 to 12/31/2006 

____________ 

q Non-County Elected Official*# q Other _____________________ 

For the following Earnings Chart, please refer to the first page of instructions. 

ENTER 

Year ________ 2000 Year ________ 2004 Year ________ 2005 Year ________ 2006 Year ________ 

YEAR 

JAN 

FEB 

MAR 

APRIL 

MAY 

JUNE 

JULY 

AUG 

SEPT 

OCT 

NOV 

DEC 

TOTAL 

MONTHS 

CREDIT 

TOTAL 

ANNUAL 

EARNINGS 

x 

NOTE: Any person who knowingly makes any false statement or falsifies or permits to be falsified any record of the Illinois Municipal Retirement Fund in an 

attempt to defraud IMRF is guilty of a Class 3 felony (40 ILCS 5/1-135). 

Regular Service 

Elected County Official Service—ECO 

SLEP Service (limitations may apply) 



Member Services Representatives 1-800-ASK-IMRF (1-800-275-4673) Fax: (630) 706-4289 

www.imrf.org 

See instructions for eligibility 

for ECO or SLEP plan. 

CERTIFICATION BY MEMBER: I certify that I received the above earnings from this governmental unit for the time indicated. For service 

in an elected office, I acknowledge that I must always contribute to IMRF while holding that same office and that I may not receive an IMRF 

pension during any term in that office. 

x 

EXAMPLE 

EARNINGS 

“X” 

IRREGULARLY 

PAID “IP” OR 

SEASONAL 

“SE” 

EARNINGS 

“X” 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

12 

SE 

SE 

$31,500 

SIGNATURE OF MEMBER 

IRREGULARLY 


SEASONAL 

“SE” 

EARNINGS 

“X” 

IRREGULARLY 


SEASONAL 

“SE” 

EARNINGS 

“X” 

IRREGULARLY 


SEASONAL 

“SE” 

PLEASE PRINT — USE BLACK INK 

City of Anywhere 0 0 0 0 0 


Councilman 

X 

X 

X 

X 

X 

X 

X 

X 

X 

Year ________ 


Year ________ 

Year ________ 

Page _____ of _____ 

Members who have established an Individual Retirement Account (IRA) for income tax purposes should be sure to read “Income tax consequences for 

members” on the second page of instructions. 


X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

EARNINGS 

“X” 

IRREGULARLY 


SEASONAL 

EARNINGS 

“SE” “X” 


0 0 0 0 0 0 0 0 0 

_______________ - __________ - ________________ 

( 0 0 0 ) 0 0 0 - 0 0 0 0 

05/01/2001 Councilman 

X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

8 12 12 

$2,400 $3,600 $3,600 

X 

02/21/2008 

02/21/2008 

09/03/1952 

IRREGULARLY 


SEASONAL 

EARNINGS 

“SE” “X” 

IRREGULARLY 


SEASONAL 

“SE” 

EARNINGS 

“X” 

1 1 

IRREGULARLY 


SEASONAL 

“SE”


Exhibit 6H 

Form 6.04A has been DISCONTINUED.


OMITTED SERVICE CREDIT VERIFICATION 

IMRF Form 6.05 (Rev. 11/10) FOR QUALIFYING PERIODS WHEN THE EMPLOYEE WAS NOT ENROLLED 


When to Use this Form 

Use this form when the member was not enrolled, and previously reported, log on to IMRF Employer Access to 

earnings and contributions for the member were not perform a wage adjustment. 

reported to IMRF. To correct earnings and/or contributions 

1. This form must be received by IMRF while the 

member is currently participating in IMRF or in 

another retirement system covered by the Illinois 

Retirement Systems Reciprocal Act. 

2. The service was rendered by a member in a position 

qualified for IMRF membership. Do not apply for 

omitted service credit for members who are now in 

qualifying positions but ask for credit for service they 

previously rendered in non-qualifying positions. If the 

member previously worked in a non-qualifying position 

that was properly classified as such, the member and 

position should not now be reclassified as qualifying. 

3. To receive omitted service credit, the member must 

meet the 600- or 1000-hour hourly standard required 

by his/her employer. 

4. The service was not previously reported to IMRF. The 

earnings for this period may or may not have been 

reported for Social Security. To correct earnings and/ 

or contributions previously reported, log on to IMRF 

Employer Access to perform a wage adjustment. 

5. The service was rendered by the member after the 

date the governmental unit joined IMRF. Use IMRF 

Form 6.07, “Application for Prior Service Credit,” 

1. Sheriff’s Law Enforcement Personnel (SLEP) Plan 

In order to establish service as SLEP service, the 

member must have been a full-time deputized sheriff. 

In limited situations, the member may have been 

a police chief or airport or forest preserve district 

police. Documentation must be submitted along 

with the application for service, verifying that the 

member qualified under the SLEP plan. See the SLEP 

supplement in the IMRF Manual for Authorized Agents 

for more detailed information. 

2. The Member Earnings Chart 

Service credit can only be granted in the month a 

member worked and received payment. EXAMPLE: A 

member hired on January 15, but first paid in February, 

would not be entitled to service credit for January. 

An exception to this rule will be made for periods of 

Seasonal Leave and members who were Irregularly 

Paid. 

a. Enter the time period of omitted service being 

applied for (“Omitted Service Period”). 

Requirements for Omitted Service Credit 


EXHIBIT 6I 

Page 1 of 3 

for eligible service rendered prior to the date the 

governmental unit joined IMRF. Refer to Form 6.07 for 

specific requirements. 

6. The form is certified by the Authorized Agent. 

7. The member pays IMRF contributions only on the 

omitted earnings. The member does not pay 

interest on omitted contributions. 

8. The member may receive service credit for 

periods without earnings, provided he or she 

either: 

• has periods of Seasonal Leave (SE) 

a. was employed in a seasonal position, and 

b. had six consecutive months of earnings within 

a 12-month period, and 

c. remained in an employment relationship 

during the seasonal leave period, and received 

earnings after the leave period. If the member 

did not receive earnings after the seasonal 

leave period, please explain why, and it will be 

determined whether service should be granted. 

OR 

• is Irregularly Paid (IP) 

The member (usually an elected official) is 

normally paid annually, bi-annually, quarterly, etc. 

b. Enter the 4-digit year in the top row of the chart 

for as many columns as you will need. If more 

than 7 years of service are being entered, please 

photocopy this form. Indicate above the chart, in 

the provided area, the current page number and 

the total number of pages submitted (Page ___ 

of ___ ). 

c. Indicate the status of the member’s service credit 

for every month of each year. Place an “x” in the 

earnings column if the member received earnings 

for that month. Or, if the member should receive 

Seasonal Leave Service or Irregularly Paid 

Service, enter “SE” or “IP.” (See number 7 above 

for SE and IP information.) 

d. If there are months the member should not receive 

service, leave them blank, or draw a line through 

all of the columns. 

e. Enter the total months of service credit earned per 

year in the second from the last row. 

f. Enter the total annual earnings per year in the 

last row. 

IMRF Form 6.05 (Rev. 11/10) Instructions continued ...

3. Authorized Agent Certification 



Member should sign and date where indicated. 

Instructions Continued 


EXHIBIT 6I 

Page 2 of 3 

5. Social Security Wage Adjustments 

If Social Security wages were also omitted, see Section 

4 of the IMRF Manual for Authorized Agents. 




establishing the past service. 

Option I is the Lump Sum Payment Plan 

The Lump Sum Payment Plan allows members 

to pay the total cost with a single payment and 

purchase all of the eligible service he or she chooses 

to purchase at once. The member may purchase a 

portion, all, or none of the past service listed on the 

payment schedule. 

2. Using funds from an IRA or another pension plan 

to purchase the service 

The member may pay for this service with a qualified 

pension plan as defined by Section 401a, 457, 403b, 

etc. of the Internal Revenue Code, or a traditional 

individual retirement account (IRA). The member 

would complete and submit IMRF Form 6.01, “Request 

for Rollover Approval,” for determination of eligibility. 



one or more months of service credit at a time. 

Members may pay as often as they like, buying back 

credit from the latest month to the earliest month of 

eligible service. However, they may not buy more 

months than indicated on the Past Service Payment 

Schedule. 


Members who want to know how the omitted service will 

affect their pension should wait until they receive the Past 

Service Payment Schedule. They then can request a 

formal pension estimate by calling 1-800-ASK-IMRF 

(1-800-275-4673) or at www.imrf.org through their secure 

Member Access Account. Members participating in a 

reciprocal system should contact their current system for 

an estimate. 

Members can also refer to the IMRF Past Service 

Booklet, which can be found online at www.imrf.org, or by 

calling 1-800-ASK-IMRF. The section titled “Is it worth it to 

purchase service” provides a detailed description of how 

to calculate the impact of service on a pension. 




reciprocal pension system. If the member has less than 

12 months of service in a reciprocal retirement system, 

that service will not be counted in the calculation of his or 

her reciprocal pension. Exception: A former teacher aide 

who transferred to a position covered by the Teachers’ 

Retirement System (TRS) and who has less than 12 

months of IMRF service credit can apply that service 

toward a reciprocal pension. A list of the 13 systems 

covered by the Act are listed in Section 5 of the IMRF 

Manual for Authorized Agents and on the IMRF website, 

www.imrf.org. Local police and fire pension funds are not 

covered by the Act. 


The governmental unit’s contribution for omitted service, 

plus interest, is made through future contribution rates. 

Therefore, a separate payment is not required. Interest is 

calculated on the contributions from the end of the omitted 

period through December 31st of the year preceding the 

current year. The actuary will take the retroactive service 

into account when annually determining the employer 

contribution rate. 


OMITTED SERVICE CREDIT VERIFICATION 

IMRF Form 6.05 (Rev. 11/10) FOR QUALIFYING PERIODS WHEN THE EMPLOYEE WAS NOT ENROLLED 

PLEASE PRINT OR TYPE -- USE BLACK INK 

STOP: IF CONTRIBUTIONS WERE WITHHELD, BUT NOT REPORTED, LOG ON TO EMPLOYER ACCESS TO PERFORM A WAGE ADJUSTMENT. 


__ Janet __ __ __ __ __ __ __ __ J. Doe ____________ 0 0 0 - __________ 0 0 - ____________ 0 0 0 0 

STREET (MAILING) ADDRESS CITY STATE ZIP + 4 

123 Birch Street Anywhere IL 60000-1234 

DATE OF BIRTH TELEPHONE NO OPTIONAL: ANTICIPATED RETIREMENT DATE 

09/03/1950 ( 0 0 0 ) 0 0 0 - 0 0 0 0 


IMRF May 1, 2005 

CURRENT EMPLOYER IMRF EMPLOYER I.D. NUMBER CURRENT POSITION 

EMPLOYER FOR WHOM SERVICE WAS RENDERED 

PARTICIPATION DATE OF CURRENT SYSTEM 

City of Anywhere 0 9 9 9 9 Dispatcher 


OMITTED POSITION 

Secretary 

EXHIBIT 6I 

Page 3 of 3 

CERTIFICATION BY AUTHORIZED AGENT: I certify that the following statements of earnings for the above applicant is in agreement 

with the governmental unit’s payroll records and represent the entire qualifying employment period determined by the governing body. 

OMITTED SERVICE PERIOD (DATES) FROM January ______________ 2000 TO _____________ 

December 2000 

For the following Earnings Chart, please refer to the Instructions on Page 1 

Page _____ 1 of _____ 1 

ENTER 

YEAR 

JAN 

FEB 

MAR 

APRIL 

MAY 

JUNE 

JULY 

AUG 

SEPT 

OCT 

NOV 

DEC 

a 

TOTAL 

MONTHS 

CREDIT 

TOTAL 

PREVIOUS 

HOURS 

WORKED 

TOTAL 

OMITTED 

EARNINGS 

Year ________ 2000 

EXAMPLE 

IRREGULARLY 

HOURS 

EARNINGS PREVIOUSLY 


SEASONAL EARNINGS 

“X” WORKED “SE” 

“X” 

x 

x 

x 

x 

x 

x 

x 

x 

x 

x 

12 

600 

$31,500 

SE 

SE 

Year ________ 

HOURS 

PREVIOUSLY 

WORKED 

IRREGULARLY 


SEASONAL 

“SE” 

Year ________ 

EARNINGS 

“X” 

HOURS 

PREVIOUSLY 

WORKED 

IRREGULARLY 


SEASONAL 

“SE” 

Year ________ 

EARNINGS 

“X” 

HOURS 

PREVIOUSLY 

WORKED 

Do you anticipate that this employee has met or will meet the hourly standard X Yes No 

IRREGULARLY 


SEASONAL 

“SE” 

Year ________ 

EARNINGS 

“X” 

HOURS 

PREVIOUSLY 

WORKED 

IRREGULARLY 


SEASONAL 

“SE” 

x 

Signature of Authorized Agent 


Date 

Choose One: I wish to establish the service on this application as: 

Regular Service Elected County Official Service—ECO SLEP Service (see instructions; limitations may apply) 

CERTIFICATION BY MEMBER: I certify that I am currently a member in the Illinois Municipal Retirement Fund or a reciprocal system, and 

that I received the above earnings from the governmental unit indicated above for the months and years indicated. 

x 





IMRF Form 6.05 (Rev. 11/10) Member Services Representatives 1- 800-ASK-IMRF (1-800-275-4673) 

www.imrf.org 

Date


CONVERSION OF REGULAR OR SLEP SERVICE CREDIT 

TO ELECTED COUNTY OFFICIAL (ECO) SERVICE CREDIT 

Exhibit 6J 

For earnings previously reported to IMRF 

Page 1 of 3 



Requirements for Converting Service Credit 

If you joined ECO before January 26, 2000 

• you can convert any earnings and contributions which 

were previously reported to IMRF under the Regular or 

SLEP plans to service credit under the ECO plan. 

If you joined ECO on or after January 26, 2000 

• you can convert only those earnings and contributions 

you earned as an elected county official which were 

previously reported to IMRF under the Regular or SLEP 

plans to service credit under the ECO plan. 

1. You must have previously participated in or currently 

participate in IMRF under the ECO plan. 

2. You earned the service while working in a position which 

qualified for IMRF membership. 

3. Earnings and contributions for the periods listed 

on this form were reported to IMRF under either 

the Regular or SLEP plans and the service (your 

contributions) is currently on deposit with IMRF. If you 

took a refund of your service, see item number 6. 

4. The county employer you worked for when you elected 

to participate in the ECO plan must have adopted a 

resolution allowing their current and former elected 

county officials to participate in ECO. IMRF Form 6.80, 

“Suggested Form of Resolution to Adopt Alternative 

Benefit Program for County Officers,” must be on file 

with IMRF. 

1. Member’s information 



2. Employer information 

Enter the requested information. 

3. Periods of participation to be converted 

If you joined ECO before January 26, 2000, you can 

convert any earnings and contributions which were 




How to pay for the service 

5. You have signed and submitted IMRF Form 6.21B, 

“Election by Elected County Official to Participate in 

IMRF Elected County Official Plan.” 

6. If you took a refund of member contributions and 

forfeited the service credit, the service can be reinstated 

and converted to ECO simultaneously using IMRF Form 

6.03, “Application for Reinstatement of Service Credit.” 

7. If you have earnings and contributions (i.e., service) 

which were never reported to IMRF, see IMRF Form 

6.04, “Application for Retroactive Service Credit” or 

Form 6.05, “Omitted Service Credit Verification,” if 

applicable. 

If you joined ECO on or after January 26, 2000, you 

can convert only those earnings and contributions you 

earned as an elected county official which were 





1. Your (member) cost 

For each month of service converted to ECO, you would 

pay IMRF an additional: 

• 3% contributions, plus interest, on Regular IMRF 

earnings converted to ECO; or 

• 1% to 3% (depending on the original contribution rate) 

contributions, plus interest, on SLEP earnings converted 

to ECO 


Your employer may pass a resolution (IMRF Form 

6.83, “Suggested Form of Resolution to Require Additional 

Member Contributions for Past Service Converted to 

the Alternate Benefit Program for County Officers”) that 

requires you to pay both the member and employer 

cost for converting service credit to ECO. 

Interest is calculated on the contributions from the 

earliest year that is being converted through December 31 

of the year preceding the current year. 

“How to pay...” continued on next page

“How to pay...” continued from front 

2. Payment Schedules 




Option I is the Lump Sum Payment Plan. 


total cost with a single payment and purchase all the 

eligible service you choose to purchase at one time. 

You can purchase a portion, all, or none of the past 

service listed on your payment schedule. 

3. Using a rollover from another pension plan to 


Exhibit 6J 

Page 2 of 3 

You may pay for service with money from a qualified 

pension plan as defined by Section 401 of the Internal 

Revenue Code. Complete and submit IMRF Form 6.01, 

“Request for Rollover Approval,” for determination of 

eligibility. 

Option 2 is the Unit Payment Plan. 


or more months of service at a time. You may pay 

as often as you like, buying back credit from the 

most recent month to the earliest month of eligible 

service. However, you may not buy more months than 


How purchasing the service will affect your pension 

If you want to know how converting your service will affect 

your pension, you should wait until you receive the Past 

Service Payment Schedule. Then you can call 

1-800-ASK-IMRF (1-800-275-4673) or call your current 

retirement system for a pension estimate before you 

determine how many months of service to purchase. 


which you can find online at www.imrf.org, or call 

1-800-ASK-IMRF to request a copy. The section titled 

“Is it worth it to purchase service” provides a detailed 

description of how to calculate the impact of service on 

your pension. 




reciprocal pension system. If you have less than 12 months 

of service with any single reciprocal retirement system, 

that service will not be counted in the calculation of your 

reciprocal pension. Exception: A former teacher aide 

who transferred to a position covered by the Teachers’ 




covered by the Act is available on the IMRF website, 

www.imrf.org, or by request from an IMRF Member Service 

Representative at 1-800-ASK-IMRF (1-800-275-4673). 

Local police and fire pension funds are not covered by the 

Act. 


1. The additional benefit costs resulting from the 

conversion of Regular IMRF or SLEP service to ECO 

service will be charged to your ECO employer (your 

employer when you elected to participate in the ECO 

plan), even if the converted service was earned with a 

different employer. 

2. Your employer may pass a resolution that requires 

you to pay both the member and employer cost for 

converting service credit to ECO. 


CONVERSION OF REGULAR OR SLEP SERVICE CREDIT 

TO ELECTED COUNTY OFFICIAL (ECO) SERVICE CREDIT 



Exhibit 6J 

Page 3 of 3 

Avoid delays—read the instructions on the previous pages before completing this form 

PLEASE PRINT OR TYPE – USE BLACK INK 


__ __ __ __ __ __ __ __ __ 

Robert J. Doe 0 0 0 - 0 0 - 0 0 0 0 

STREET (MAILING) ADDRESS CITY, STATE AND ZIP + 4 

123 Birch Street Anywhere, IL 60000 

DATE OF BIRTH TELEPHONE NO. OPTIONAL: ANTICIPATED RETIREMENT DATE 

July 14, 1947 (000) 000 -0000 

NAME OF CURRENT IMRF EMPLOYER 

County of Anywhere 0 0 0 0 

CURRENT POSITION 

IMRF EMPLOYER I.D. NUMBER 

FIRST DATE OF PARTICIPATION IN ECO PLAN 

County Auditor November 3, 1999 

NAME OF COUNTY EMPLOYER WHEN YOU ELECTED TO PARTICIPATE IN ECO 

Anywhere 

PERIOD(S) OF PARTICIPATION (REGULAR SERVICE CREDIT) TO BE CONVERTED 

Enter the periods of employment you wish to convert to SLEP service credit. The date you opted into the ECO plan will determine 

what periods may be converted. 

Refer to item 3 under “Instructions for Completing...” to determine which Regular/SLEP service credit can be converted. 

COVERAGE PERIOD OR 

NAME OF IMRF EMPLOYER(S) TITLE OF OFFICE OR POSITION TERM OF OFFICE 

City of Anywhere Accountant 5/6/1987 to 10/31/1999 

CERTIFICATION BY MEMBER: 

I hereby certify that, 

• I have previously participated or currently am participating in IMRF under the Elected County Official (ECO) plan and have 

submitted IMRF Form 6.21, “Election by Elected County Official to Participate in the Elected County Official Plan,” or 6.21B, 

“Election by Elected County Official to Participate in the Elected County Official Plan rev. on 1/26/00” 

• The service credit (contributions) covering employment periods listed above are currently on record with IMRF, and 

• I now request that you provide me with the cost to convert this service credit so it may be considered ECO service credit. 

x 


August 15, 2012 

Date 




Member Services Representatives 1-800-ASK-IMRF (1-800-275-4673) 7:30 a.m. to 5:30 p.m. 

www.imrf.org


APPLICATION FOR PRIOR SERVICE CREDIT 


Avoid delays—read the instructions below and on the back before completing this form. 

1. The service was rendered by the member prior to the date 

the governmental unit joined IMRF. 

2. The service was rendered in a position which qualified for 

membership in IMRF. 

Requirements for Prior Service Credit 

Exhibit 6K 

Page 1 of 3 

(c) in a qualifying elected position with the governmental 

unit when it joined IMRF, but did not elect to participate 

at that time. A resolution (IMRF 6.64) must be filed with 

IMRF affirming the elected position is qualifying, if not 

already on file. 

3. The member was either: 

(a) employed by the governmental unit in a qualifying 

position on the date the governmental unit joined IMRF, 

or 

(b) no longer working for the governmental unit on the 

date it joined IMRF, but returned to work for the same 

governmental unit after it joined IMRF and contributed 

to IMRF under that employer for at least two years, or 

4. This form is completed by the Authorized Agent and 

certified by the Authorized Agent and member. 

NOTE: A member is not eligible for prior service during 

periods in which he or she was separated from 

service or was employed in a non-qualifying position. 

1. Member and Employer Information 

Enter the member’s name, Social Security number, 

address, and telephone number. Enter the governmental 

unit’s name and IMRF employer number. 

Optional: enter the member’s retirement date. 

2. Prior Service Period 

For new employers: Do not enter any information in this 

section. Your IMRF Field Representative will help you 

complete this section. 

For all other employers: Complete as required. 

3. Most Recent Salary and Service 

Enter the member’s earnings (and the service credit 

earned) for the last 36 months prior to employer joining 

IMRF. A maximum of 36 months of earnings will be 

entered. If the employee has been employed for less than 

36 months, enter the salary and service information for the 

appropriate number of months. 

Enter member service credit earned for each year. 

Use the earnings/wages entered here to determine 

the “Average Monthly Wage for Benefit,” to be used in 

the event any part of the prior service period is used to 

calculate an IMRF retire ment, death, or disability benefit as 

defined by the Illinois Pension Code. 


4. Employment Periods 

Members can be granted service credit for months without 

earnings for seasonal leave, irregularly paid months or 

military leave (IMRF Form 6.62 must be completed). 

5. If the member has periods of Seasonal Leave 

The member may receive service credit for the periods 

without earnings provided he or she: 

1. was employed in a seasonal position, 

2. had six consecutive months of earnings within a 12 

month period, and 

3. remained in an employment relationship during the 

seasonal leave period, and received earnings after the 

leave period. If the member did not receive earnings 

after the seasonal leave period, please explain why, and 

we will determine whether service should be granted. 



Mem bers whose employer joined IMRF after January 1, 

1998, will be credit ed 20% of their total prior service, up 

to 5 years, free of charge. 

The member can purchase the remaining portion of prior 

service by paying the appropriate IMRF contributions 

with interest. The amount of member contributions due 

is based upon the member’s annual salary on the date 

the employer joined IMRF. Interest is calculated on the 

contributions from the first year of prior service through 

December 31st of the year preceding the current year. 




establishing the past service. 

Option 1 is the Lump Sum Payment Plan 

The Lump Sum Payment Plan allows the member to 

pay the total cost with a single payment and purchase 

all the eligible service he or she chooses to purchase 

at one time. The member can purchase all, a portion, 

or none of the past service listed on the payment 

schedule. 


Exhibit 6K 

Page 2 of 3 



one or more months of service credit at a time. 

Members may pay as often as they like, buying back 

credit from the latest month to the earliest month of 

eligible service. However, they may not buy more 

months than indicated on the Past Service Payment 

Schedule. 

3. Using funds from an IRA or another pension plan to 


The member may pay for service with a qualified pension 

plan as defined by Section 401a, 457, 403b, etc. of 

the Internal Revenue Code, or a traditional individual 

retirement account (IRA). The member would complete 

and submit IMRF Form 6.01, “Request for Rollover 

Approval” for determination of eligibility. 


Members who want to know how the prior service will affect 

their pension should wait until they receive the Past Service 

Payment Schedule. Then, they can call 1-800-ASK IMRF 

(1-800-275-4673) or their current system for a pension 

estimate. 

They can also refer to the IMRF Past Service Booklet, 


1-800-ASK-IMRF. The section titled “Is it worth it to purchase 

service” provides a detailed description of how to calculate 

the impact of service on a pension. 

Purchase of prior service will NOT make a Tier 2 

Member eligible for Tier 1. 




reciprocal pension system. If the member has less than 12 

months of service in a reciprocal retirement system, that 

service will not be counted in the calculation of his or her 

reciprocal pension. Exception: A former teacher aide who 

transferred to a position covered by the Teachers’ Retirement 

System (TRS) and who has less than 12 months of IMRF 

service credit can apply that service toward a reciprocal 

pension. A list of the 13 systems covered by the Act can be 

found in Section 5 of the IMRF Manual for Authorized Agents 

and on the IMRF website, www.imrf.org. Local police and fire 

pension funds are not covered by the Act. 

The governmental unit’s contribution for prior service is paid 


adjustment to its employer payment is not required. 


Each year the employer’s contribution rate is recalculated 

based upon its employees’ credited service through the end 

of the year. Any prior service purchased during the year is 

reflected in that calculation. 


APPLICATION FOR PRIOR SERVICE CREDIT 


PLEASE PRINT OR TYPE -- USE BLACK INK 

1. MEMBER’S LAST NAME MIDDLE INITIAL FIRST NAME JR., SR., II, ETC. SOCIAL SECURITY NUMBER 

STREET (MAILING) ADDRESS CITY, STATE AND ZIP + 4 TELEPHONE NO 

____________ - __________ - ____________ 

( ) 

EMPLOYER NAME EMPLOYER IMRF I.D. NUMBER OPTIONAL: ANTICIPATED RETIREMENT DATE 

2. PRIOR SERVICE PERIOD Do not enter any information in Columns A, B, or C. Your IMRF Field Representative will help you complete these columns. 

(Indicate service credit in months, e.g., 3 years 4 months = 40 months; 8 years 2 months = 98 months) 

NON-CONTRIBUTORY SERVICE: SERVICE CREDIT A MEMBER RECEIVES AT NO COST; LIMITED TO A MAXIMUM OF 60 MONTHS 

CONTRIBUTORY SERVICE: SERVICE CREDIT A MEMBER MAY PURCHASE BY PAYING THE APPROPRIATE MEMBER CONTRIBUTIONS PLUS INTEREST 

A B C 

DATE EMPLOYER JOINED IMRF___________ 1, ______ 

MONTH YEAR 

DATE EMPLOYEE ELIGIBLE FOR IMRF_______________ 

(MO/YR) 

THRU END OF MONTH PRIOR TO MONTH 

EMPLOYER JOINED IMRF_________________________ 

(MO/YR) 

EQUALS 

TOTAL SERVICE CREDIT (MONTHS)_________________ 

ACTUAL EARNINGS PRIOR TO SERVICE CREDIT, IF CONTINUOUSLY EMPLOYED, ENTER START M/D/Y AND CURRENT M/D/Y. 

YEAR DATE EMPLOYER JOINED IMRF IN MONTHS IF EMPLOYMENT TERMINATED & EMPLOYEE RETURNED, ENTER AS SEPARATE PERIODS. 

TOTALS: $ 

TOTAL SERVICE CREDIT_ _________________________ 

(e.g., 8 years 2 months = 98 months) 

EQUALS 

NON-CONTRIBUTORY 

SERVICE 

1) 

2) 

3) 

4) 

_________________________ 

MULTIPLIED BY 20% 

________________________ 

(60 MONTH MAX) 

3. MOST RECENT SALARY/SERVICE 4 EMPLOYMENT PERIODS 

Exhibit 6K 

Page 3 of 3 

Roe J. Henry 0 0 0 0 0 0 0 0 0 

123 Ash Street Anywhere, IL 60000 0 0 0 0 0 0 - 0 0 0 0 

City of Anywhere 00000 

2009 10,000.00 8 

2008 11,000.00 12 

2007 12,000.00 12 

33,000.00 12 

TOTAL SERVICE CREDIT_ _________________________ 

LESS 

NON-CONTRIBUTORY SERVICE_ ___________________ 

EQUALS 

CONTRIBUTORY SERVICE______________________ 

FROM THROUGH POSITION NO. OF MONTHS 

(MM/DD/YY) 

(MM/DD/YY) 

5/1/01 12/31/01 Meter Reader 8 

1/1/02 12/31/02 Meter Reader 12 

1/1/03 12/31/03 Meter Reader 12 

$ ______________ 33,000.00 ÷ MONTHS___________ 32 = __________________ 

$1,032.00 

AVERAGE MONTHLY 

WAGE FOR BENEFIT 

ANNUAL GROSS EARNINGS 

13,000.00 

ON DATE EMPLOYER JOINED IMRF: $________________ 

5) 

6) 

7) 

8) 

CERTIFICATION BY AUTHORIZED AGENT 

I certify that the preceding statement of earnings and service for the above member is in agreement with the governmental unit’s payroll records and 

represents the entire qualifying employment period determined by the governing body. 

x 


This is to certify that I was employed and received the above earnings from the above governmental unit and; that I agree, or disagree (if disagree, 

please send letter of explanation) with the period verified by the Authorized Agent. 

x 


NOTE: Any person who knowingly makes any false statement or falsifies or permits to be falsified any record of the Illinois Municipal Retirement Fund in an 

attempt to defraud IMRF is guilty of a Class 3 felony (40 ILCS 5/1-135). 


August 15, 2009 

For FIELD REP CALC AUDIT CONTRIBUTORY PRIOR SERVICE NON-CONTRIBUTORY PRIOR SERVICE 

Use by 




IMRF Form 6.07 (Rev. 12/10) Member Services Representatives 1-800-ASK-IMRF (1-800-275-4673) 

www.imrf.org 

Date 

August 15, 2009 

Date


Exhibit 6 M 

Form 6.08 has been DISCONTINUED


NOTICE OF ENROLLMENT IN IMRF 


PLEASE PRINT OR TYPE ALL ANSWERS 

Exhibit 6N 

Page 1 of 2 

How to complete this form 

Employment Information 

The Authorized Agent completes questions 9 through 15. Refer to Section 3 of the Manual for Authorized Agents for information on 

eligibility requirements for participation in IMRF. 

• Question 1 – Member name 

The name entered in Box 1 should be the name used to report 

the member’s earnings to IMRF. Using the same name will 

better ensure that the member receives proper credit for 

contributions made and service earned. 

• Questions 2 - 10 


• Question 11 

Enter the requested information for each position the member 

will hold. If the date employed is different than the participation 

date (the date the member began working in the position(s) 

qualified under the annual hourly standard), please explain 

in the space provided. The Illinois Pension Code does not 

recognize reasons such as probationary, temporary or trial work 

period. Enter a detailed explanation why the member was not 

enrolled immediately. Refer to Section 3 of the Manual for 

Authorized Agents for more information regarding participation 

requirements. Full Time/Part Time applies only to SLEP. Circle 

the appropriate response. 

• Question 12 

Check “yes” if the member is in a position that requires at 

least six months of consecutive service but less than 12 in any 

12-month period. 

OR 

Check “yes” if the member’s earnings will be reported to IMRF 

other than on a monthly basis, e.g. annually, quarterly, etc. 

If answered “yes” to either question and seasonal employer is 

not a school district, park district, or recreation association, or 

if the employee will be paid irregularly (applies only to elected 

officials) check the months the employee will not be paid. 

• Question 13 A 

If the member is a police chief eligible for transfer into the 

Sheriff’s Law Enforcement Personnel plan (SLEP), please 

complete and attach IMRF Form 6.22, “Election of Police Chief 

to Participate as SLEP Member.” (Refer to Section 3 of the SLEP 

supplement to the Manual for Authorized Agents for information 

on SLEP eligibility requirements.) 

• Question 13 B 

Check “yes” if the member has been sworn in to perform police 

duties. (Refer to Section 3 of the Manual for Authorized Agents 

for eligibility requirements.) 

• Question 13 C 

Check “yes” if the member will perform fire protection duties. 

(Refer to Section 3 of the Manual for Authorized Agents for 

eligibility requirements.) 

• Question 13 D 

Check “yes” if the member will provide instructional support in 

the classroom, tutor, supervise students, or perform clerical tasks 

required by teachers. 

• Question 13 E and 14 

If the member is an elected official, appointed to elected office, 

or is a city hospital worker, please complete and attach IMRF 

Form 6.21, “Election to Participate.” 

• Question 15 - COUNTY EMPLOYERS ONLY 

If the employer is a county and the member is/was elected or 

appointed to elected office, complete question 15. If “yes” is 

checked and the member elected to participate in the Elected 

County Official plan, complete and attach IMRF Form 6.21B, 

“Election of Elected County Official to Participate in ECO.” 

Submit Form 6.10 via Employer Access. 

AUTHORIZED AGENT PLEASE NOTE: 

Social Security card/number 

Tape a copy of the member’s Social Security card in the box. 

IMRF uses Social Security numbers to identify members’ 

accounts and files. Social Security numbers are also used on IRS 

statements issued by IMRF. 

This is mandatory if employer has Internet access. 

If the name in Box 1 is not the same as shown on the Social 

Security card, the member should take evidence to substantiate 

the change of name to a local Social Security office so a new 

card may be issued. Once issued, please forward a copy to 


If the member does not have a copy of his/her Social Security 

card, IMRF will use the Social Security number entered on this 

form. Any IRS penalties that result from an incorrect Social 

Security number will be the responsibility of the IMRF employer. 

If the member obtains a Social Security card after being enrolled, 

please forward a copy to IMRF. 

When calling 

When calling IMRF regarding enrollment, ask for the 

Enrollment Auditor. 


10009 



Member Services Representatives 1-800-ASK-IMRF (1-800-275-4673) 

www.imrf.org

X 

NOTICE OF ENROLLMENT IN IMRF 


Please print or type — Use Black Ink. 

Please do not use a highlighter anywhere on the form. 

MEMBER INFORMATION (to be completed by member - please print or type) 

1. Last Name First Middle Initial Jr., Sr., II, etc. 

2. Social Security Number 

3. Mailing Address 

__ __ __ - __ __ - __ __ __ __ 

TAPE A COPY OF 

SOCIAL SECURITY CARD 

IN THIS SPACE 

City 

4. Home Telephone No. 

State Zip + 4 

5. Birth Date: 

County 

month/day/year 

If a copy of the Social Security card is not attached, IMRF will 

use the Social Security number entered on this form. Any IRS 

penalties that result from an incorrect Social Security number 

will be the responsibility of the IMRF employer. (Do not staple 

card—use tape and please stay within this border.) 

( ) 

6. Martial Status Single Married Divorced Widowed 7. Gender Female Male 

8. Are you currently participating or have you previously participated in IMRF or any other Illinois Public Pension systems 

No 

Yes [please check the box(es) to identify the pension system(s)] 

IMRF (If indicating IMRF, are you currently collecting a pension from IMRF) Yes No 

Chicago Public School Teachers’ Cook County Annuity & Benefit Fund General Assembly Retirement System 

Judges’ Retirement System Laborers’ Annuity & Benefit Fund Cook County Forest Preserve Annuity & Benefit 

Metro Water Reclaim. Retirement System Municipal Employees Annuity & Benefit Fund Park Employees’ Annuity & Benefit Fund 

State Universities Retirement System State Employees’ Retirement System State Teachers’ Retirement System 

I certify this information is correct to the best of my knowledge and belief. 

Employee signature (write; do not print or type) 

Submit Form 6.10 via Employer Access. 

EMPLOYMENT INFORMATION - ALL FIELDS MUST BE COMPLETED (to be completed by employer — please print or type) 

9. Employer Name 10. Employer IMRF I.D. Number 

This is mandatory if employer has Internet access. 

11. Position Information 

(SLEP ONLY: 

Date employed Participation date* Employee will participate in: CIRCLE ONE) 

mo day yr mo day yr (circle one) 

Position Title(s) 

Regular ECO SLEP ( FT / PT ) 

Regular ECO SLEP ( FT / PT ) 

*If date employed is earlier than participation date, explain in detail why the member was not enrolled immediately. The Illinois 

Pension Code does not recognize “probationary,” “temporary,” or “trial work period.” Refer to Section 3 of the Authorized Agents Manual for 

details on participation requirements. 

Date 

Exhibit 6N 

Page 2 of 2 

12. Will employee work in a seasonal position....................................... No Yes OR 

Is employee an elected official who will be paid irregularly.............. No Yes 

If employee will hold a seasonal position and the seasonal employer is not a school district, park district, or recreation association, OR 

if employee is an elected official who will be paid irregularly, check the months the employee will not be paid: 

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec 

13. Is employee: 

A. Police chief eligible for transfer into IMRF for SLEP coverage 

No Yes (attach Form 6.22) 

B. Performing police duties................................ No Yes 

C. Performing fire protection duties................... No Yes 

D. Performing teacher aide duties..................... No Yes 

(see instructions for examples) 

E. City hospital worker 



10009 

14. Elected official or appointed to elected office 





www.imrf.org 

15. For County employers only: Has member elected to participate 

in the Elected County Offical (ECO) plan 

No Yes (attach Form 6.21B) 

I certify this information is correct to the best of my knowledge and belief, and that the person named above is employed in a position 

which qualifies him or her for membership in IMRF with the above employer. 

Authorized Agent signature (write; do not print or type) 

Date 

X

Exhibit 6O 

Page 1 of 4 

DESIGNATION OF BENEFICIARY 


Questions Call 1-800-ASK-IMRF (1-800-275-4673). 

Who can complete this form 

We can accept the signature of the member only on this form. If someone other than the member 

signs this form, including an agent under a power of attorney, the form will not be accepted. 

If you make any changes to this form 

If you make any changes to your beneficiary information, you must initial the change. If you do not, 

the form will not be accepted. 

Benefits payable upon your death 

If you die while participating in IMRF, IMRF will pay your beneficiary(ies) a: 

a. Lump sum death benefit, which can be equal to one year’s salary, plus a refund of the balance 

in your IMRF member account, 

OR 

b. Monthly Surviving Spouse pension, plus $3,000 (if eligible). [A child’s pension is payable if you are 

participating in the Elected County Official plan, your spouse is not eligible for a surviving spouse 

pension, and you have single (unmarried or not in a civil union) children under the age of 18 at 

the time of your death.] 

How to complete this form 

Primary Beneficiary(ies) 

If you do not have a valid Designation of Beneficiary form on file with IMRF, your estate is 

automatically your beneficiary. 

If you want any other arrangement, you must submit a Designation of Beneficiary form to IMRF. 

You can name any person, church, trust, charity or organization. If your primary beneficiaries do not 

survive you, IMRF will pay the benefit to your Secondary Beneficiary(ies) or to your estate. 

Note of caution for married members or members in a civil union 

If you want to ensure that your spouse is eligible for a Surviving Spouse pension, you must 

name your spouse as your only primary beneficiary. If you divorce, your former spouse is no 

longer your beneficiary. If you want any other arrangement, you must file a new Designation of 

Beneficiary form. 

If you name more than one Primary Beneficiary 

The persons listed become “co-beneficiaries” and will share the lump sum death benefit 

according to the percentages you enter. If you leave the percentages blank or if the shares 

do not add up to 100%, the form will not be processed. 

If you are naming someone under the age of 21 (a minor) 

Death benefits will be paid in care of the minor’s guardian. If you want someone other than the 

guardian to receive the IMRF benefit on behalf of the minor, you may name a custodian, who 

is 21 years of age or older, under the Illinois Uniform Transfers to Minors Act. Enter the name 

of the individual you wish to appoint as custodian followed by “as custodian for ____________ 

(name of minor) under the IUTMA.” 

IMRF Form 6.11 (Rev. 06/12) page 1 of 2 continued on next page...

Exhibit 6O 

Page 2 of 4 

If you are naming a trust 

Please provide the number and/or date of the trust. 

Secondary Beneficiary(ies) 

Your Secondary Beneficiary(ies) will receive the death benefit payable by IMRF if no Primary 

Beneficiary survives. You can name any person, church, trust, charity or organization as your 

Secondary Beneficiary. You may also name more than one Secondary Beneficiary. 

Signature, date and returning the completed form 

You must sign, date, and file this form with IMRF for it to be effective. 

You can mail the completed form to IMRF directly, or you can give the completed form to your 

employer, who will mail it to IMRF. The information on this form does not become effective until it is 

on file in IMRF’s Oak Brook or Springfield office, even if your employer has a copy. 

IMRF Form 6.11 (Rev 06/12) page 2 of 2

DESIGNATION OF BENEFICIARY 


Please print or type — use black ink and do not use a highlighter on the form. 

Exhibit 6O 

Page 3 of 4 

1. Member Information 

Employee Name 

Social Security Number 

John J. Doe 

______ 

0 0 0 

- _____ 

0 0 

- ________ 

0 0 0 0 

Mailing Address (street address; city; state; zip+4 if known) 

Birthdate (MM/DD/YYYY) 

123 Oak Street 

04/01/1981 

Anywhere, IL 60000 

Daytime Telephone No. 

( 0 0 0 ) 0 0 0 - 0 0 0 0 

Marital Status 

Never Married X Married Civil Union Divorced Widowed 

Gender of Spouse 

Spouse’s Last Name First Name Middle Initial Maiden (if applicable) Marriage/Civil Union Date (MM/DD/YYYY) 

Doe Janet M. 06/14/2004 

Male 

Female 

2. Primary Beneficiary(ies) 

(For your spouse to be eligible for a Surviving Spouse pension, he/she must be your ONLY primary beneficiary.) 

Refer to instructions if naming a minor or a trust. 

First Name Last Name Social Security Number Relationship % Share 

(optional) 

to each 

Janet Doe 0 0 0 - 0 0 - 0 0 0 0 Wife 100 


Important: If the total of all primary beneficiary shares does not equal 100%, 

or if you leave the percentages blank, IMRF will NOT process the form. 

3. Secondary Beneficiary(ies) (Will receive IMRF death benefits if no Primary Beneficiary survives.) 

4. Signature (write, do not type or print) of member only 

(Form will not be accepted if someone other than member signs form.) 

X 

Read the conditions on the reverse side. 

Date 

Completed form may be mailed to: Illinois Municipal Retirement Fund 

2211 York Road, Suite 500, Oak Brook, IL 60523-2337 

1-800-ASK-IMRF (1-800-275-4673) Fax 1-630-706-4289 

TOTAL 100% 

First Name Last Name Social Security Number Relationship % Share 

(optional) 

to each 

NOTE: After the employer enrolls a member online, 

IMRF mails a partially pre-populated Designation of 

Beneficiary form to the member’s home with a cover 

letter and self-addressed, postage-paid envelope. 

Important: If the total of all secondary beneficiary shares does not equal 100%, 

or if you leave the percentages blank, IMRF will NOT process the form. 

TOTAL 100% 

The letter confirms the member’s participation in 

IMRF and asks the member to complete and return 

the Designation of Beneficiary form.

Exhibit 6O 

Conditions of IMRF Designation of Beneficiary 

Page 4 of 4 

This is a brief summary of your IMRF death benefit provisions. 

Your rights and obligations as an IMRF member are governed by Article 7 of the Illinois Pension Code. 

This designation of beneficiary: 

• Provides for payment of IMRF death benefits and 

revokes (cancels) any prior beneficiary designation. 

• Will be effective when you sign it and it is on file in 

IMRF’s Oak Brook or Springfield office. 

• Is subject to Illinois law and to rules and regulations 

established by the IMRF Board of Trustees. 

The acceptance of this designation by IMRF does not mean 

that a death benefit will be payable if you are not otherwise 

entitled to one. Whether a benefit is payable, and the amount 

paid, will be determined at the time of death under applicable 

laws and regulations. 

You cannot name a creditor (such as a bank, credit union, 

or loan company) as your beneficiary as a means of providing 

security for a debt. 

Benefits payable 

• Lump sum death benefit OR 

• Surviving Spouse pension 

• Child’s pension 

A child’s pension is payable if the member was 

participating in the Elected County Official Plan and the 

member’s spouse is not eligible for a surviving spouse 

pension, but the deceased children who are unmarried/ 

not in a civil union, under the age of 18. 

Surviving spouse pension 

If you want your spouse to be eligible for a Surviving 

Spouse pension, you must name your spouse as your only 

Primary Beneficiary. 

If your spouse is not your only Primary Beneficiary, 

• the right to a Surviving Spouse pension is 

forfeited (lost). 

• only a lump sum benefit is payable (which 

can be equal to one year’s salary, plus a refund 

of the balance in your IMRF member account). 

In the case of the member with many years 

of service credit, the forfeited Surviving 

Spouse pension may be of greater value 

than the lump sum benefit. 

Naming a minor(s) as beneficiary(ies) 

Death benefits payable to a minor (under the age of 21) are 

paid in care of the minor’s guardian. 

If you want someone other than the minor’s guardian to 

receive the IMRF benefit on behalf of the minor, you may name 

a custodian (who is 21 years of age or older) under the Illinois 

Uniform Transfers to Minors Act. 

This is done by entering the name of the individual you 

wish to appoint as custodian followed by “as custodian for 

__________(name of minor) under the IUTMA.” 

Shares to each named beneficiary 

You must write in specific shares (percentages), if 

naming more than one beneficiary. These shares MUST 

add up to 100% or the form will not be processed. 

If a named beneficiary does not survive, his or her shares 

will be distributed among any surviving beneficiaries. However, 

if you want his or her shares to be distributed to his or her 

heirs by blood line (not a spouse), add “per stirpes” after the 

beneficiary’s name. 

Death benefit payments 

IMRF death benefits are paid to your: 

• Primary Beneficiary you designated on your most 

recent valid designation of beneficiary form on file with 


• Estate if you have no valid designation form on file. 

If none of your Primary Beneficiary(ies) survives, the 

benefit will be paid to your Secondary Beneficiary(ies). 

If none of your Primary or Secondary Beneficiary(ies) 

survives, the benefit will be paid to your estate. 

If you divorce 

If you named your spouse as a your primary beneficiary 

but you later divorce, your former spouse is no longer your 

beneficiary. If you want any other arrangement, you must file a 

new Designation of Beneficiary form.


EMPLOYER NAME 

SECTION B SECTION A 

CHECK ONE (CORRECTED/MISSING, CHANGE PLAN, OR ADD PLAN) 

CORRECTED OR MISSING INFORMATION FROM FORM 6.10: 

DATE EMPLOYED (MM/DD/YYYY) PARTICIPATION DATE (MM/DD/YYYY) EMPLOYEE WILL PARTICIPATE IN: 

Regular SLEP (FT / PT) 

DEPT. NAME 

* 

MEMBER EMPLOYMENT INFORMATION 


PLEASE READ INSTRUCTIONS ON BACK BEFORE COMPLETING. 

Doe John A. 000 - 00 - 0000 

POSITION TITLE 

If date employed is earlier than participation date, please explain: 

CHANGE PLAN (check one only) 

(When changing from any ECO plan to Regular or SLEP, please contact IMRF, as form 6.28 may be required) 

From Regular ......................... To SLEP (FT / PT) 

From ECO Regular ................ To Regular 

From ECO Regular ................ To SLEP (FT/PT) 

From ECO Regular ................ To ECO SLEP 

PREVIOUS POSITION TITLE 

NEW POSITION TITLE (SEE SECTION D BELOW) 

EMPLOYER IMRF I.D. NUMBER 


11/21/2013 11/21/2013 X 

Public Works 

Engineer 

* 

From SLEP ........................To Regular 

Exhibit 6P - Page 1 of 2 

From ECO SLEP ...............To Regular 

From ECO SLEP ...............To SLEP (FT / PT) 

From ECO SLEP ...............To ECO Regular 

PLEASE PRINT 

DATE MEMBER TERMINATED POSITION (MM/DD/YYYY) 

DATE BEGAN WORKING IN POSITION (MM/DD/YYYY) 

SECTION D SECTION C 

NEW DEPARTMENT NAME 

FIRST MONTH WAGES WILL BE REPORTED 

FOR NEW POSITION 

NEW POSITION TITLE (See Section D below) PARTICIPATES UNDER DATE PARTICIPATION BEGAN (MM/DD/YYYY) 

NEW DEPARTMENT NAME 

Regular 

SLEP (FT/PT) 

#If date member began new position is different than participation date, explain. 

DATE MEMBER BEGAN NEW POSITION (MM/DD/YYYY)# 

FIRST MONTH WAGES WILL BE REPORTED 

FOR NEW POSITION 

For any NEW position listed above is member: (see instructions on back) 

A. Working in a seasonal position............................. No Yes OR 

An elected official who will be paid irregularly...... No Yes 

If member will hold a seasonal position and the seasonal employer is not a school district, park district, or recreation association, OR 

is an elected official who will be paid irregularly, check the months the member will not be paid: 

Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 

B. Police chief eligible for transfer into IMRF for SLEP coverage 


C. Performing police duties....................... No Yes 

D. Performing fire protection duties........... No Yes 

E. Performing teacher aide duties............. No Yes 

(see instructions for examples) 

I certify this information is correct to the best of my knowledge and belief. 

SIGNATURE OF AUTHORIZED AGENT (WRITE; DO NOT PRINT.) 

X 

ADD PLAN 

F. City hospital worker ........ No Yes (attach Form 6.21) 

G. Elected official or appointed to elected office 


H. For SLEP employers only: Was SLEP member appointed by: 

Sheriff Merit Commission 


11/30/2013 


2211 York Road Suite 500 Oak Brook, IL 60523-2337 

Member Services Representatives 1-800-ASK IMRF (1-800-275-4673) Fax: (630) 706-4289 

www.imrf.org 

IMRF Form 6.19 (Rev. 09/2013) Page 1 of 2

• “PLAN” refers to either Regular, SLEP, or ECO. 

• “SLEP” refers to Sheriff’s Law Enforcement Personnel 

plan, “ECO” refers to the Elected County Official Plan 

(either ECO Regular or ECO SLEP). 

• For any SLEP plan, please circle full time or part time 

(FT / PT). 

• If a member was reported as Regular but should have 

been reported as SLEP, complete IMRF Forms 6.71, 

“Certification of Sheriff’s Law Enforcement Service,” 

and 3.20, “Employer’s Report of Adjustments.” 

INSTRUCTIONS 

Exhibit 6P - Page 2 of 2 

• If a member is terminating employment or no longer 

qualifies for IMRF participation, complete IMRF Form 

6.41, “Notice of Termination,” (must be submitted 

through Employer Access) 

• Participation in IMRF is governed by Article 7 of the 

Pension Code. Refer to Section 3 of the Manual for 

Authorized Agents for details on IMRF participation. 

SECTION A 

• Use this section to provide missing or corrected 

information regarding a member’s Form 6.10, “Notice 

of Enrollment.” 

• Please complete Section D if applicable. 

SECTION B 

• Use this section if a member is changing IMRFcovered 

positions and the change will result in the 

member changing IMRF plans. 

• Please be sure to complete Section D to provide 

information about the member’s new position. 

• Please be sure to attach the appropriate form as 

indicated. 

• If a member was reported as Regular but should have 

been reported as SLEP, complete IMRF Forms 6.71, 

“Certification of Sheriff’s Law Enforcement Service,” 

and 3.20, “Employer’s Report of Adjustments.” 

• When changing from any ECO plan to Regular or 

SLEP, please contact IMRF as Form 6.28, “Revocation 

of Election to Participate in Elected County Official 

Plan,” may be required. 

SECTION C 

• Use this section if a member will assume an additional 

IMRF-covered position and, under the additional 

position, the member will participate under a different 

IMRF plan. 

• Please be sure to complete Section D to provide 

information about the member’s new position. 

SECTION D 

Complete this section if the member is changing 

positions OR will participate in a new position. 

For Questions: 

A Check “yes” if the 

• Member is in a position that requires at least six 

months of consecutive service but less than 12 in 

any 12-month period OR 

• Member’s earnings will be reported to IMRF other 

than on a monthly basis, e.g. annually, quarterly, 

etc. 

If answer is “yes” to either question and the seasonal 

employer is not a school district, park district, or 

recreation association, or if the employee will be paid 

irregularly (applies only to elected officials), check the 

months the employee will not be paid. 

B Check “yes” if the member is a police chief eligible for 

transfer into SLEP. Please complete and attach IMRF 

Form 6.22, “Election of Police Chief to Participate as 

SLEP Member.” 

C Check “yes” if the member has been sworn in to 

perform police duties. 

D Check “yes” if the member will perform fire protection 

duties. (Refer to Section 3 of the Manual for Authorized 

Agents for eligibility requirements.) 

E Check “yes” if the member will provide instructional 

support in the classroom, tutor, supervise students, or 

perform clerical tasks required by teachers. 

F If the member is a city hospital worker, please complete 

and attach IMRF Form 6.21, “Election to Participate.” 

G If the member is an elected official or appointed to 

elected office, please complete and attach IMRF Form 

6.21, “Election to Participate.” 

H For SLEP employers only: If the member is a SLEP 

member, indicate if member was appointed by either a 

Sheriff or Merit Commission. 




www.imrf.org 


MEMBER INFORMATION CHANGE 


PLEASE PRINT OR TYPE 

INSTRUCTIONS 

• When changing a Social Security number, please attach a copy of the new Social Security card. 

• If name change is due to change in marital status, please attach Form 6.11, “Designation of Beneficiary.” This 

form can be downloaded from our web site at www.imrf.org or processed via your IMRF Member Access online 

account. Log on to: www.imrf.org/myimrf 

• Please file a copy of this form with your employer. 

• Forms must be signed for processing by IMRF. 

NOTE: You may also change your name, address, telephone number and marital status via 

IMRF Member Access. Log on to: www.imrf.org/myimrf 

PREVIOUS INFORMATION - Complete all items 

MEMBER’S LAST NAME FIRST NAME MIDDLE INITIAL JR., SR., II SOCIAL SECURITY NUMBER 

Jones Mary A. ______ 000 - _____ 00 - ________ 0000 

STREET (MAILING) ADDRESS 

CITY, STATE AND ZIP 

123 Ash Avenue City of Anywhere, IL 60000 

COUNTY DAYTIME TELEPHONE NUMBER (with Area Code) BIRTH DATE (MM/DD/YYYY) 

Happy (000) 000 - 0000 09/03/1950 

MARITAL STATUS 

X 

NEVER MARRIED MARRIED CIVIL UNION DIVORCED WIDOWED 

Exhibit 6Q 

CORRECT INFORMATION - Complete all items 

NEW ADDRESS EFFECTIVE DATE (MM/DD/YYYY) 

06/15/2014 

MEMBER’S LAST NAME FIRST NAME MIDDLE INITIAL JR., SR., II NEW SOCIAL SECURITY NUMBER 

Jones Mary A. 



417 Addison Avenue Elsewhere, IL 61111 

COUNTY DAYTIME TELEPHONE (with Area Code) BIRTH DATE (MM/DD/YYYY) 

Charmed (000) 000 - 0000 09/03/1950 

MARITAL STATUS 

NEVER MARRIED MARRIED CIVIL UNION DIVORCED WIDOWED 

IMRF ACCOUNT STATUS (Check only one please.) 

X 

X 

______ 000 - _____ 00 - ________ 0000 

Attach copy of new Social Security Card 

ACTIVE — You currently participate in IMRF. 

RETIRED — You currently have a retirement claim with IMRF. 

ACTIVE — You currently have a disability claim with IMRF. 

INACTIVE — You no longer participate in IMRF. However, 

you still have funds on account. 

SIGNATURE (Member must sign below.) Member information changes 

X 

___________________________________________________________ 

Mail this completed form to: 


2211 York Road, Suite 500, Oak Brook, Illinois 60523-2337 

Member Services Representatives 800/ASK-IMRF (1-800-275-4673) 


can be submitted online 

via the secure Employer Access area 

of IMRF’s website, www.imrf.org. 

Refer to Section 2, Paragraph 2.90 

___________________________________ 


OR fax this form to: 


Records Department 

FAX #(630) 706-4289


Exhibit 6R 

ELECTION TO PARTICIPATE FOR QUALIFYING POSITION 


INSTRUCTIONS 

• Elected officials and city hospital workers have the option to participate if their position qualifies them for participation 

in IMRF. In order to elect to participate, they should complete this form and file it with IMRF. 

• If an elected official chooses to participate in IMRF, that official must always participate while holding that same office, 

including subsequent terms of office. This means that an elected official who joins IMRF may not receive an IMRF 

pension during any term in that office. 

• After the elected official or city hospital employee begins participation, he/she is eligible to apply for a maximum of 50 

months of retroactive service credit. Use IMRF Form 6.04, “Application for Retroactive Service Credit.” 

• The employer must have on file with IMRF Form 6.64, “Resolution Relating to Participation by Elected Officials,” 

certifying that the position qualifies for participation in IMRF. 

• A person appointed to a vacant elected position is considered to be an elected official and must also file this form if 

he/she elects to participate in IMRF. 

• If an IMRF member currently holds another qualifying position and is electing to contribute member contributions 

through an elected or city hospital position which would not qualify in and of itself, please use form 6.23, “Election to 

Contribute Under Additional Position.” You can also refer to the Manual for Authorized Agents, Section 6.10. 

• All elected officials and city hospital employees whose position qualifies them for participation in IMRF, even if they 

choose not to join, are considered to be participants in an employer sponsored pension plan and therefore subject to 

the IRA deductibility limits imposed by the Internal Revenue Code of 1986. 

PLEASE PRINT OR TYPE - USE BLACK INK 

Employee’s First name Middle Initial Last Jr., Sr., II, etc. Social Security Number 

James Rowe __ 0 0 __ __ 0 __ 0 __ 0 __ 0 0 __ 0 __ 0 __ 

Current Position Title Department Code Elected/Appointed Official....... Y N 

City Hospital Worker............... Y N 

Custodian 

Employer name 

Street (mailing) address City, State and Zip + 4 

Employer IMRF I.D. Number 


123 Spruce Street Anywhere, IL 60000 

CERTIFICATION BY ELECTED OFFICIAL OR CITY HOSPITAL EMPLOYEE 

I certify that I am electing to participate in the Illinois Municipal Retirement Fund and have authorized payroll deductions to be made 

from my earnings as required under the Illinois Pension Code. I understand that this election may not be revoked, and that I must 

continue IMRF participation in all subsequent terms in this office.* 

X 

____________________________________________________ 

Signature of Elected Official or City Hospital Employee 

February 12, 2012 

_________________________________________ 

Date 


I certify that the position which the above named person occupies qualifies him or her for membership in IMRF.* 

____________________________________________________ 


February 12, 2012 

_________________________________________ 

Date 

* I understand that any person who knowingly makes any false statement or falsifies or permits to be falsified any record of the 

Illinois Municipal Retirement Fund in an attempt to defraud IMRF is guilty of a Class 3 felony (40 ILCS 5/1-135). 


Suite 500, 2211 York Road, Oak Brook Illinois 60523-2374 




Election by elected county official to continue participation 

in IMRF elected county official plan (Plan closed by P.A. 97-0609, effective 8/26/2011) 

IMRF Form 6.21B (Rev. 02/12) 

EXHIBIT 6S 

Page 1 of 2 

Employer name 

please refer to the instructions on the back of this form 

Please print or type — use black ink 

Elected County Official’s First name Middle Initial Last Jr., Sr., II, etc. 

James 

Smith 

Social Security Number Current Office Title Current Office Expires on: Department Code 

0 __ __ 0 __ 0 __ 0 0 __ 0 __ __ 0 __ 0 __ 0 Treasurer 11/06/2014 


DECLARATION BY ELECTED COUNTY OFFICIAL 

I elect to continue to participate in the IMRF Elected County Official (ECO) plan during my new term of office. 


Anywhere County 0 0 0 0 0 

123 USA Drive Anywhere, IL 60000 

ACKNOWLEDGEMENTS 

• I will contribute 7.50% of earnings and will be eligible for ECO benefits as described in the IMRF publication, “IMRF 

Revised Elected County Official Plan under P.A. 91-0685.” 

• To be eligible for the IMRF Tier 1 ECO formula, I need eight years of ECO service in the same position with the same 

county. To be eligible for the IMRF Tier 2 ECO formula, I need eight years of ECO service in the same position with the 

same county, but 10 years of total service credit. 

• My participation in the ECO program expires at the end of my current term of office. If I am re-elected, I must 

complete a new Form 6.21B at the beginning of my new term of office to remain in the ECO program. 

• If am appointed to an elected position that qualifies for the ECO program, and wish to continue in ECO in that position, 

I must complete a new Form 6.21B at the beginning of my new term of office to remain in the ECO program. 

• If I choose to stop participating in ECO, that decision will be irrevocable. 

____________________________________________________ 

Signature of Elected County Official 

11/06/2012 

_________________________________________ 

Date 


I certify that the position which the above named person occupies qualifies him or her for membership in ECO. I further certify that 

ECO member contributions (7.50%) will be made from the member’s earnings beginning with earnings paid in 

November 6 12 

____________________________ 20________. (Refer to instructions on back.) 

____________________________________________________ 


11/06/2012 

_________________________________________ 

Date 

IMRF Form 6.21B (Revised 02/12) 



Member Services Representatives 1-800-ASK-IMRF (1-800-275-4673)

Instructions 

EXHIBIT 6S 

Page 1 of 2 

Authorized Agent: 

• After filing this form, the Authorized Agent should notify its payroll unit to continue to deduct the appropriate member 

IMRF contribu tions of 7.5%. 

Member: 

Participating in the ECO Plan 

• You must have first elected to participate in the ECO Plan before August 26, 2011. 

• Your participation in the ECO program expires at the end of your current term of office. 

– If you are re-elected, you must complete a new Form 6.21B at the beginning of your new term of office to 

remain in the ECO program. 

– If you leave office (e.g., complete the term of office and are not re-elected or if you quit or resign), your 

participation in the ECO Plan will terminate unless you hold another ECO-eligible position with the same county 

and file a new Form 6.21B. 

– If you are appointed to an elected position that qualifies for the ECO program and you wish to continue in ECO in 

that position, this form must also be completed. 

IMRF Form 6.21B (Revised 02/12)

ELECTION OF POLICE CHIEF TO PARTICIPATE 

AS A SLEP MEMBER 



Exhibit 6T 

INSTRUCTIONS 

Chief of Police: 

• Before electing to participate in IMRF, the chief should contact IMRF and request an estimate of the cost to transfer his/her police 

pension service before enrolling. 

• If the police chief wishes to elect to participate as SLEP, he/she must do so within 90 days of his/her appointment as police chief. 

Authorized Agent (AA) 

• Before enrolling the police chief in IMRF, the AA should obtain an estimate of the cost to the municipality of the chief’s IMRF 

participation. 

• The AA would enroll the police chief in IMRF via Employer Access. (IMRF Form 6.22 will be automatically generated after the 

online enrollment is complete. The form may be printed, completed and submitted via mail or fax.) 

• The AA should promptly notify the payroll unit to make the proper IMRF participating deductions from the chief’s next payroll 

earnings and to report these deductions via Employer Access. 

Please retain a copy of this form for your records. 


James Smith __ 0 __ 0 __ 0 __ 0 __ 0 __ 0 __ 0 __ 0 0__ 


TELEPHONE NUMBER + AREA CODE 

123 Main Street Anywhere, IL 60000 (000) 000 - 0000 

EMPLOYER NAME 

STREET (MAILING) ADDRESS CITY, STATE AND ZIP + 4 


Village of Anywhere 0 0 0 0 0 

456 Village Drive Anywhere, IL 60000 

Approximate 

Was Service 

List All Police Pension Fund Service You Wish To Transfer Commissioned Forfeited 

Period 

By Refund 

City of Anywhere 6/2000 - 9/2006 

■ Yes 

■ No 

■ Yes 

■ Yes 

■ Yes 

■ No 

■ No 

■ No 


I certify that I am an appointed chief of police, am currently eligible to participate in the police fund, have elected to participate in the 

Illinois Municipal Retirement Fund as a SLEP member, and have authorized deductions to be made from my earnings as required 

under the provisions of the Illinois Pension Code. 

I understand that this election may not be revoked as long as I perform police duties with an IMRF employer. 

____________________________________________________ 

Signature of Chief of Police 

________________________________________ 

11/30/2010 

Date 


11/15/2010 

I certify that the above named member was appointed police chief of this municipality on (date) ____________________________. 

____________________________________________________ 

________________________________________ 

11/30/2010 


Date 



Suite 500, 2211 York Road, Oak Brook Illinois 60523-2374 630/368-1010 

Member Services Representatives 800/ASK-IMRF (1-800-275-4673)


ELECTION TO CONTRIBUTE UNDER ADDITIONAL POSITION 

Exhibit 6U 

IMRF Form 6.23 (6/99) 

INSTRUCTIONS 

• A member who currently participates and also holds a nonqualifying elective office or works in a city hospital position with the 

same employer, has the option of making member contributions under the additional position. 

• Use this form for an IMRF member who currently works in a qualifying position and is electing to contribute member contributions 

through a position which does not qualify for participation in and of itself. 

• A participating member who holds an elective office that qualifies for participation in and of itself should file IMRF Form 6.21, 

“Election to Participate for Qualifying Position.” You can refer to the Manual for Authorized Agents, Section 3.65 for more 

information. 

• After filing this form, the Authorized Agent should promptly notify the payroll unit to deduct the member IMRF contributions from 

the member's next payroll earnings and to report the contributions on their Monthly Deposit Report. 

• If this position becomes qualifying at a later date, this election may not be revoked, and the employer 

must file IMRF Form 6.64, “Resolution Relating to Participation by Elected Officials,” certifying that the 

position qualifies for participation in IMRF. 

PLEASE PRINT OR TYPE — USE BLACK INK 

Member’s First name Middle Initial Last Jr., Sr., II, etc. Social Security Number 

Robert J. Doe __ 0 0 __ 0 __ 0 __ 2 __ __ 3 4 __ 5 __ 6__ 

Qualifying Position Title Is position: Elected/Appointed Official ■ Y ■ N 

Accounting Manager 

City Hospital Worker ■ Y X■ N 

Additional Position Title Is position: Elected/Appointed Official ■ Y ■ N 

Alderman 

City Hospital Worker ■ Y X■ 

N 

Employer name 




600 Main Street Anywhere, IL 60000-1111 


I certify that I am currently participating in the Illinois Municipal Retirement Fund, am electing to participate under the additional 

position listed above and have authorized payroll deductions to be made from my earnings as required under the Illinois Municipal 

Retirement Fund Act. If this position becomes qualifying at a later date, I understand that this election may not 

be revoked except as provided by law. I further understand that if I stop participating under a qualifying position, I will not be 

allowed to make member contributions under this additional position. 

X 

X 

____________________________________________________ 


________________________________________ 

August 18, 2006 

Date 


I certify that the above named member currently participates in IMRF through the employer listed above and that he/she occupies 

both positions. 

____________________________________________________ 


________________________________________ 

August 18, 2006 

Date 



Service Representatives 1-800-ASK-IMRF (1-800-275-4673 7:30 A.M. to 5:30 P.M.) 



INSTRUCTIONS 

40-YEAR SERVICE ELECTION TO CEASE CONTRIBUTIONS 


• Before completing this form, please request a pension estimate from IMRF. It may be in your best interest to stop your 

contributions; you cannot change your mind once the form is submitted. 

• A member who currently participates in Regular IMRF, Sheriff’s Law Enforcement Personnel Plan (SLEP) or the Elected County 

Officials Plan (ECO) and has 40 or more years of service credit can elect to stop making IMRF contributions. 

• Use this form for an IMRF member who currently works in a qualifying position and is making IMRF contributions. 

• This election will not be effective until the first day of the month after acquiring 40 years of service or the first day of the month after 

this election is received by IMRF, whichever is later. 

• After filing this form, the Authorized Agent should promptly notify its payroll unit not to deduct the member IMRF contributions from 

the member's next payroll earnings that would be reported on their Monthly Wage Report. 

Employer Name 


Member’s First Name Middle Initial Last Jr., Sr., II, etc. Social Security Number 

_________ — ________ — ____________ 




I elect to stop making contributions to the Illinois Municipal Retirement Fund. I understand that by stopping my IMRF contributions 

I will: 

• Receive that portion of my salary (4.50 percent Regular IMRF, 6.50 percent SLEP [7.50 percent after June 1, 2006], 

7.50 percent ECO) which would have been contributed to IMRF, as additional pay less federal and state income taxes 

• Freeze my final rate of earnings as of the effective date of this election; 

• Continue to be treated as a participating member by the Illinois Municipal Retirement Fund for purposes of 

death, and disability benefits; and 

• Not be eligible to receive a retirement benefit until I cease working in a qualifying position and apply for a 

retirement annuity. 

I also understand that this election is irrevocable once it is made. 

Exhibit 6V 

John J. Doe 0 0 0 0 0 0 0 0 0 

Village of Anywhere 0000 

1000 Green Street Anywhere, IL 60000-0000 

____________________________________________________ 


August 18, 2012 

________________________________________ 

Date 


I certify that the above named member currently participates in IMRF through the employer listed above and that he/she occupies a 

qualifying position. 

Complete for ECO member who joined ECO PRIOR to January 26, 2000. 

Do NOT complete for Regular IMRF or SLEP member or if ECO member joined ECO on or after January 26, 2000. 

1. Please enter the member’s final annual salary earned as a member of the ECO Plan: ....$ ______________________________ 

2. Please enter the member’s annual stipend as a member of the ECO Plan: .....................$ _____________________________ 

____________________________________________________ 


August 18, 2012 

________________________________________ 

Date 



2211 York Road Suite 500, Oak Brook Illinois 60523-2337 

Member Services Representatives 1-800-ASK-IMRF


SECTION 2 — EMPLOYER INFORMATION 

EMPLOYER NAME 

REVOCATION OF ELECTION TO PARTICIPATE 

IN ELECTED COUNTY OFFICIAL PLAN 



MEMBER’S LAST NAME FIRST MIDDLE INITIAL JR., SR., II, ETC. SOCIAL SECURITY NUMBER 

CURRENT OFFICE TITLE 

IMRF Form BW-6B (Rev. 05/2013) 

____________ - _________ - ____________ 

CURRENT OFFICE EXPIRES ON (MM/DD/YYYY) 


SECTION 3 - CERTIFICATION BY ELECTED COUNTY OFFICIAL 

I hereby revoke my previous election to participate in the IMRF Elected County Official (ECO) plan. My participation in IMRF will 

continue. I understand that by revoking my election in the ECO Plan, I will: 

• Freeze my ECO final rate of earnings, and 

• NOT be eligible to participate in the ECO plan at a future date, and 

• NOT be eligible to apply to convert any Regular or SLEP Service credit as ECO service credit, and 

• Continue to participate in the Illinois Municipal Retirement Fund in the Regular IMRF or SLEP plan 

(as appropriate), and 

• Be eligible only for Regular/SLEP plan death benefits (Surviving Spouse pension of 50%) until I retire with an 

ECO pension, and 

• Be eligible for ECO member death benefits only when I retire with an ECO pension. 

I further understand and agree that this revocation of participation in the ECO plan MAY NOT BE RESCINDED. I will not be 

eligible to earn IMRF ECO service credit now or in the future. 

SIGNATURE (WRITE - DO NOT PRINT OR TYPE)* 


X 

PLEASE PRINT 

Member Mary A. 0 0 0 0 0 0 0 0 0 

County Auditor 11/2/2013 

County of Anywhere 0 0 0 0 0 

*NOTE: 

• If you joined ECO before January 26, 2000, the revocation is effective on the last day of the month, 

e.g., if the form is signed on March 2nd, the revocation is effective on March 31st. 

• If you joined ECO on or after January 26, 2000, the revocation is effective on the date this form is signed. 

SECTION 3 - AUTHORIZED AGENT’S CERTIFICATION 

AUTHORIZED AGENT’S NAME (Please print.) 

Annie Agent 

DAYTIME TELEPHONE NUMBER (with Area Code) FAX NUMBER (with Area Code) EMAIL ADDRESS 

Information required only for those members who joined ECO prior to January 26, 2000. 

Do NOT complete if member joined ECO on or after January 26, 2000. 

I certify that the above-named member currently participates in IMRF through the employer listed above and that he/she occupies a 

qualifying position. 

1. Please enter the member’s final annual salary earned as a member of the ECO plan.......$ _______________________________ 

2. Please enter the member’s annual stipend as a member of the ECO plan.........................$ _______________________________ 


X 

TITLE 

Business Manager 


07/14/2013 




www.imrf.org 

Exhibit 6W 

(000) 000 - 0000 (000) 111 - 2222 aagent@countyofanywhere.com 

07/14/2013 

36,375.77 

1,500.00


ELECTION TO MAKE/CHANGE 

VOLUNTARY ADDITIONAL CONTRIBUTIONS 


INSTRUCTIONS 

• Voluntary Additional Contributions (VAC) are limited to 

10% of IMRF reportable earnings by Section 7-173 of the 

Illinois Pension Code. The employer does not match these 

contributions, nor are these contributions tax-deferred. 

PLEASE PRINT 

Income tax information on reverse side of this form. 

Exhibit 6X - Page 1 of 2 

• VAC on deposit at the beginning of a year are credited with 

interest (7-1/2% current rate) at the end of the year. Current 

year contributions are not credited interest until the end of 

the following year. 

• Additional contributions begin as soon as IMRF receives 

your application and your employer begins reporting your 

VAC to IMRF. 

• On the Monthly Report of Member Wages and Contributions 

the member will be listed on a second page which shows 

“Voluntary Additional Contributions.” 

• The member may stop Voluntary Additional Contributions 

at any time by notifying the Authorized Agent. IMRF 

should be notified as to the last month Voluntary Additional 

Contributions will be reported. 

• VAC may be withdrawn before terminating IMRF 

participation and must be withdrawn if regular IMRF 

contributions are withdrawn. If withdrawn before age 59-1/2 

(age 55 if terminating employment with the IMRF employer), 

income tax penalties may be applicable unless the taxable 

amount is rolled over into an eligible retirement plan. Partial 

withdrawals are not allowed. 

• At retirement Voluntary Additional Contributions may be 

taken in a lump sum or applied to a monthly annuity. The 

employer does not contribute to this annuity. 


Doe John J. _______ 0 0 0 - ____ 0 0 - _______ 0 0 0 0 

EMPLOYER NAME 




I elect to (check one): 

X 5 

• Make Voluntary Additional Contributions to the Illinois Municipal Retirement Fund at the rate of ________% 

(NOT TO EXCEED 10%) 

• Change my Voluntary Additional Contributions to the Illinois Municipal Retirement fund to the rate of _________% 

(NOT TO EXCEED 10%) and authorize my employer to deduct these contributions from my earnings. 

employer to deduct these contribuAtions from my earnings. 

______________________________________ 

X 

SIGNATURE OF MEMBER 

_____________ 

11/21/2013 



I certify that Voluntary Additional Contributions will be made from the member’s IMRF reportable earnings beginning with earnings 

paid in 

January 14 

_______________________________ 20 _____ at the rate specified. 

X 

______________________________________ 


11/21/2013 

___________________________________ 




Member Services Representatives 1-800-ASK-IMRF (1-800-275-4673) Fax (630) 706-4289 

www.imrf.org 


EXPLANATION AND INCOME TAX INFORMATION 

Exhibit 6X - Page 2 of 2 

NOTE: Effective February 1, 2014, if a member continues working for his or her IMRF employer and wishes to take a 

refund of VAC, only the VAC, without the interest, can be withdrawn. The interest must stay on deposit until the 

member stops working for his or her IMRF employer. The interest will continue to earn interest until the member 

withdraws it after terminating employment. At retirement, a member may annuitize his or her VAC if the account 

balance is $4,500 or more. 

1. IMRF VOLUNTARY ADDITIONAL CONTRIBUTIONS 

IMRF members may have their employer deduct up to 10% from each payment of their IMRF reportable earnings 

and remit these deductions to IMRF as voluntary additional contributions (VAC). Additional contributions begin as 

soon as IMRF receives your application and your employer begins reporting your VAC to IMRF. 

2. APPLICATION OF VOLUNTARY CONTRIBUTIONS 

VAC may be applied as follows: 

A. If upon termination of participation regular member IMRF contributions are withdrawn, then VAC must also be 

withdrawn. 

B. If upon termination of participation before retirement regular member IMRF contributions are left on deposit, the 

VAC may be left on deposit or withdrawn in a lump sum. 

C. Upon retirement, VAC with interest may be applied to monthly annuity for life or withdrawn in a lump sum. 

D. The member may stop making VAC at any time. The accumulated contributions with interest may be left on 

deposit or withdrawn in a lump sum. Partial lump sum withdrawals are not allowed. 

E. Upon death, the accumulated VAC with interest are paid to the member’s beneficiary(ies). 

3. INTEREST CREDITING ON VOLUNTARY ADDITIONAL CONTRIBUTIONS 

VAC are deposited in a separate account for each member. These accounts are not matched by the employer. 

Interest is credited to each account at the end of the year upon the opening balance at the beginning of the year. 

The rate of interest is currently 7-1/2%, the amount determined as the long term rate for actuarial purposes. The 

interest rate is set by the IMRF Board of Trustees and can be changed at any time. The procedures for crediting 

interest are established by state law. 

4. TAX TREATMENT AND LIMITATIONS 

The interest on accumulated contributions is subject to income tax in the year it is withdrawn unless rolled over into 

an eligible retirement plan. If the member is less than age 59-1/2 (age 55 if terminating employment with the IMRF 

employer) and is not totally and permanently disabled, the withdrawn interest is also subject to income tax penalties 

unless rolled over into an eligible retirement plan. 

5. WITHDRAWALS 

If a member who is currently making VAC applies to withdraw those contributions, all VAC, plus interest if any, 

accumulated up to December 31 of the previous year will be refunded. Current year contributions may not be 

withdrawn by a member who will continue to make VAC. 

A member who is no longer making VAC and who applies to withdraw those contributions will be paid all VAC on 

deposit, plus interest if any. Partial withdrawals of VAC are not allowed. If the accumulated interest is not directly 

rolled into an IRA or other qualified retirement plan, IMRF is required by federal law to make a tax withholding of 

20% of the interest. 



Member Services Representatives 1-800-ASK-IMRF (1-800-275-4673) Fax (630) 706-4289 

www.imrf.org 


IMRF BENEFIT PROTECTION LEAVE 


1. In order to apply for leave service, you must still be 

employed in an IMRF-covered position. 

2. You are allowed to establish a maximum of 12 months of 

Benefit Protection Leave over your entire IMRF career. 

If this completed form is on file with IMRF, you will 

maintain eligibility for disability or death benefits if you 

meet the following requirements: 

A. Disability benefits are payable if the disability 

occurs during the leave period and if: 

1. Member Information 



Requirements for IMRF Benefit Protection Leave 

(1) You have at least one year of contributing service 

other than the leave, have continuous service 

(including the Benefit Protection Leave) of one 

year prior to the date of disability, and this form 

has been filed prior to the date of disability; 

or 

(2) You have at least five years of service credit 

(which may include noncontributing prior service 

credit), the last year of which immediately 

precedes the leave, and this form has been filed 

prior to the date of disability; 

or 

(3) You qualify under clauses (1) or (2) above but 

you: 

Maintaining Eligibility for IMRF Benefits 

a. had an interruption in service of less than 

three months with the same employer in the 

12 months preceding the date of disability 

and were not paid a separation benefit; 


3. To qualify, the unit of government with which you were 

employed during the leave period, must certify the 

Benefit Protection Leave. 

or 

Exhibit 6Y - Page 1 of 3 

Avoid delays—read all 

instructions before 

completing this form. 

b. had any interruption in service after 20 or 

more years of creditable service but were 

not paid a separation benefit and returned 

to service prior to the date of disability. 

Note: In order to receive disability benefit payments, you 

will have to pay for the Benefit Protection Leave 

Service. 

B. Death benefits are payable if death occurs during 

the Benefit Protection Leave period only if you have 

at least one year of creditable service in addition to 

the service granted for the leave. Your cost of the 

leave up to the date of death will be deducted from 

the IMRF death benefit. 

C. Retirement service credit for the period of absence 

(not to exceed 12 months) is granted only after you 

pay the IMRF contributions plus interest. Remember, 

you must still meet the IMRF vesting requirement to 

qualify for a pension. 

4. Certification by Authorized Agent 

Your employer’s IMRF Authorized Agent enters the 

requested information. 

2. Certification by Member 

Enter the dates of the leave and number of months of 

leave. Sign and date where indicated. If the end date is 

not known, refer to the “Leave of Absence with Future 

End Date” section on page 2. 

3. Enter the name and ID number of the employer at the 

time of the leave. 

5. Certification by Clerk or Secretary of 

Governing Body 

Clerk or secretary of your employer’s governing body 

must certify the Benefit Protection Leave. 

Note: This application will NOT be processed if 

you submit it without the Authorized Agent and 

governing body certification. 





www.imrf.org 

Page 1 of 3

How do you pay for the Leave 


1. Your costs (member contributions) for the leave 

period are calculated by multiplying your average 

monthly earnings by the number of months of the leave 

of absence. Determine the monthly average by adding 

the IMRF reported earnings for the 12 months prior to 

the leave and dividing by twelve. The member cost is 

based upon IMRF member contributions applicable to 

your Plan, plus interest. 

2. IMRF will mail you a Past Service Payment Schedule 



Option I - Lump Sum Payment Plan 


total cost with a single pay ment and purchase all past 

service at once. 

Option 2 - Unit Payment Plan 


or more months at a time. You may pay as often as 

you like, buying credit from your earliest to your most 

recent month of service. However, you may not buy 

more months than indicated on the Past Service 

Payment Schedule. 

3. Do you want to use funds from an IRA or another 

pension plan to pay for the leave 

You may pay for service with a qualified pension plan as 

defined by Section 401a, 457, 403b, etc. of the Internal 

Revenue Code, or with a traditional individual retirement 

account (“IRA”). Please complete and submit IMRF 

Form 6.01, “Request for Rollover Approval,” for 

determination of eligibility. 

NOTE: If your Leave of Absence has a future end date, you will NOT receive a Past Service Payment Schedule. 

However, you WILL receive an estimate of the cost of the Leave. Do not send in payment based on the estimate. 

Payment is only accepted after a formal Past Service Payment Schedule is sent to you. 

See section below for more information about Leave of Absence with Future End Date. 

The employer’s contribution for leave service is made 


employer payment is not required. The actuary will take 


Leave of Absence with Future End Date 

the service into account when annually determining the 

employer contribution rate. 

Members and employers should pay special attention 

to Benefit Protection Leaves that end at a future date. If 

an exact future date is indicated, the application will be 

processed and an estimated cost will be based upon the 

member returning at that time. 

Important: If the member returns earlier or later than 

that date, the cost indicated on the estimate letter will be 

incorrect. Please advise IMRF’s Past Service Unit as soon 

as possible. 

If an exact future date is not indicated, IMRF cannot 

process the application until an exact date is known. To 

protect the member’s death and disability benefits, the 

employer should submit the leave form with a cover letter 

explaining that the 

(1) exact date is unknown at this time and 

(2) employer will send a copy of the leave form with the 

exact date when it is known. 

IMRF will delay processing and will not issue a Payment 

Schedule to the member until the employer submits the 

end date of the leave. Please note: IMRF will not send a 

reminder to request the end date. 

Estimating the cost of a leave with a future end date 

In order to estimate the cost of a Benefit Protection Leave 

that has a future end date, it is important for the employer 

to indicate the amount of pay, if any, the member will be 

paid in the month the member returns from the leave. Enter 

this amount in “Estimated/ Exact Earnings to be Reported 

in the Month the Employee Returns to Work” (Question 6 

under “Certification by Authorized Agent”) on the form. 




www.imrf.org 


IMRF BENEFIT PROTECTION LEAVE 



Avoid delays—read all 

instructions before 

completing this form. 

PLEASE PRINT - You may also enter information into the PDF Form 6.32 at www.imrf.org. 

Print, sign, and mail or fax the form to IMRF (contact information below). 

MEMBER’S LAST NAME FIRST NAME MIDDLE INITIAL (JR.SR.II,ETC) SOCIAL SECURITY NUMBER 

Doe John J. 0 0 0 0 0 0 0 0 0 

STREET (MAILING) ADDRESS CITY, STATE AND ZIP DAYTIME TELEPHONE NUMBER (with area code) 

123 Spruce Street Anywhere, IL 60000-0000 ( 0 0 0 ) 0 0 0 - 0 0 0 0 

CURRENT EMPLOYER 



I certify that I will be (or have been) on leave of absence beginning________________________ and ending_____________________ , 



for a total of _________ months. (Indicate on Line 2 below) 

3 

_______________ - ________ - ________________ 


07/15/2013 10/15/2013 

I understand that service credit (not more than 12 months) for this leave cannot be established until I have paid my IMRF member 

contributions in an amount equal to the approximate contributions I would have made if actively employed during the leave of absence, plus 

interest (if applicable). 

MEMBER SIGNATURE 

X 


06/26/2013 

EMPLOYER AT TIME OF LEAVE 

City of Elsewhere 1 1 1 1 1 


I certify that (1) I have calculated the estimated employer cost of the above member’s leave, (2) I have advised the governing body of the 

amount of such cost and (3) that it will be paid through future monthly contributions. 

1. Average Monthly Earnings 

(Determine the monthly average by dividing by 12 the 

IMRF reported earnings for the 12 months prior to the leave) $ 

2. Number of Months Leave (limited to 12 months) 

3. Total estimated earnings that would have been paid $ 

during the leave of absence (line 1 times line 2) 

4. Average Employer Cost Rate 

5. Estimated cost of this leave to employer (line 3 times 11%) $ 


6. Estimated/exact earnings to be reported when the employee Month in which earnings amount Amount 

returns to work (see bottom of previous page) will be reported November, 2013 $ 10,499.99 

AUTHORIZED AGENT SIGNATURE 

X 

CERTIFICATION BY CLERK OR SECRETARY OF GOVERNING BODY 

3,499.98 

X 11.00% 


I certify that at a regular or special meeting held on_______________________________ , the__________________________________ ’s 


EMPLOYER 

Governing Body approved the leave of absence stated herein and the estimated employer cost as herein determined. 

3 

10,499.99 

1,154.99 

06/26/2013 

06/27/2013 City of Anywhere 

SIGNATURE CLERK OR SECRETARY DATE (MM/DD/YYYY) 

X 

Clerk 06/28/2013 

APPLICATION WILL NOT BE PROCESSED WITHOUT AUTHORIZED AGENT AND BOARD CERTIFICATION 




www.imrf.org 



OUT-OF-STATE CREDIT AUTHORIZATION 


Exhibit 6Z 

Page 1 of 2 

INSTRUCTIONS AND REQUIREMENTS ON REVERSE SIDE 


Member’s First Name Middle Intial Last Name Social Security Number 

Jane M. Rowe 321-00-0001 

Member Mailing Address City, State, and ZIP Current Position 

123 Main Street Anywhere, IL 60000 Deputy City Manager 

Current Employer Name 

Employer Number 


Certification by Member 

City of Sterling 

I certify that I was an employee of _____________________________________________________________________________, 

Name of Local Government 

_______________________________________from Colorado ____________________________to July 1, 1998 _______________________________ 

July 1, 2003 

Name of State Date Date 

in the position(s) of _________________________________________________________________________________________ 

Accounting Manager 

such service having been covered under ________________________________________________________________________ 

Colorado Municipal Employees Fund 

Name of Public Employee Pension System 

whose address is ___________________________________________________________________________________________ 

3764 Aspen Avenue Sterling Colorado 80000 

Street City State Zip Code 

and that I have irrevocably forfeited all service credits in said pension system and am not entitled to benefits of any type 

therefrom. I understand that no service credit will be established under the Illinois Municipal Retirement Fund until I have made the 

required payment to IMRF. 

_______________________________ August 18, 2009 ___________________________________ _______________________________ 

000-888-5555 

Date Member’s Signature Member’s Daytime Telephone No. 

Certification by Clerk or Secretary of Governing Body 

I certify that a regular or special meeting held on____________________ August 15, 2009 , the __________________________________________ 

City Council 

Date 

Name of Governing Body 

of ________________________________________________ City of Anywhere 

authorized the granting of service credits for out-of-state service with 

Name of Governmental Unit 

the out-of-state governmental unit named herein from _____________________ 7/1/1998 to ____________________ 7/1/2003 

(not to exceed 120 

Date 

Date 

months for the above named member). 

________________________ August 1, 2009 

_________________________________ Clerk 

___________________________________________ 

Date Clerk or Secretary Signature 


2211 York Road, Suite 500, Oak Brook Illinois 60523-2374, 630/368-1010 

Member Services Representatives 1-800/ASK-IMRF (1-800-275-4673) 


OUT-OF-STATE SERVICE CREDIT AUTHORIZATION 

INSTRUCTIONS 

Exhibit 6Z 

Page 2 of 2 

REQUIREMENTS: 

1. The member is actively participating in IMRF and has completed two years of IMRF contributing service. 

2. The member was an employee of a local government in another state; and, as such, participated in a 

public employee pension system of that state. 

3. The member has now irrevocably forfeited all rights to a benefit from that pension system. 

4. The member completes and certifies the Certification by Member. 

5. The governing body authorizes the granting of these service credits. 

6. The clerk or secretary of the governing body completes and signs the Certification by Clerk or Secretary 

of Governing Body. 

7. The member pays IMRF contributions and interest. The contributions are calculated by multiplying the 

average monthly earnings for the first 24 months of reported earnings with the employer authorizing the 

out-of-state service by 10 percent. This amount is then multiplied by the number of months of service that 

the member wishes to transfer to IMRF. Interest is calculated from the end of the qualifying two-year 

period of IMRF contributing service. 

PAYMENT OF CONTRIBUTIONS AND INTEREST: 

IMRF will mail the applicant a Past Service Payment Schedule which offers two payment plan options for 

establishing the out-of-state service. Option I is the Lump Sum Payment Plan and Option II is the Unit 

Payment Plan. The Lump Sum Payment Plan allows applicants to pay the total cost with a single payment 

and purchase all out-of-state service at once. The Unit Payment Plan allows applicants to purchase one or 

more months at a time. Applicants may pay as often as they like, buying back credit from the latest month 

to the earliest month of eligible service. However, they may not buy more months than indicated on the 

Past Service Payment Schedule. 

A member may pay for out-of-state service with a conduit IRA established with contributions from a 

qualified pension plan as defined by Section 401(a) of the Internal Revenue Code. A conduit IRA is one that 

has no other contributions other than monies from a 401(a) pension plan and investment income earned on 

those monies. 

EMPLOYER'S COST: 

The governmental unit's contribution for out-of-state service is made through future contribution rates. 

Therefore, a separate payment is not required. The actuary will take the out-of-state service into account 

when annually determining the employer contribution rate. This is the rate shown on IMRF Form 3.10, 

“Monthly Deposit Report.” 


APPLICATION BY A MEMBER OF THE GENERAL ASSEMBLY 

FOR SERVICE CREDIT AS AN ELECTED OFFICIAL 


Exhibit 6AA 


MEMBER’S LAST NAME FIRST MIDDLE INITIAL SOCIAL SECURITY NUMBER 

MEMBER’S ADDRESS 

Doe Robert J. 000-02-3456 

TITLE OF ELECTED POSITION 

123 Spruce Street Alderman 

EMPLOYER FOR WHOM SERVICE WAS RENDERED 


City of Anywhere 9 9 9 9 


I certify that earnings, for the above IMRF member, shown in the following statement are in agreement with the governmental 

unit’s payroll records. 

MONTHS OF SERVICE CREDIT 

MONTHS OF SERVICE CREDIT 

CALENDAR WITH WITHOUT CALENDAR WITH WITHOUT 

YEAR EARNINGS EARNINGS EARNINGS* YEAR EARNINGS EARNINGS EARNINGS* 

1993 800 8 

1994 1,200 12 

1995 1,200 12 

1996 1,200 12 

1997 1,200 12 

1998 1,200 12 

1999 1,200 12 

2000 400 4 

*PI - (Paid Irregularly) 

I further certify that, 

(1) The earnings reported above are the total amount paid to the official named herein whose qualifying position and 

service was rendered as a 

❑ Full time elected Official ❑ Part time elected Official ❑ Governing Body Member 

( A resolution must be on file with IMRF affirming the above elected positioni ndicated qualified the official for 

membership.) 

(2) The member is entitled to service for the number of months indicated above as without earnings (PI). These are 

months during which the member was in office but received no pay because payment was made at various intervals. 

____________________________________________________ 

X 

August 18, 2006 

________________________________________ 


Date 

CERTIFICATION BY GENERAL ASSEMBLY MEMBER 

I certify that my service as an elected official was in a position which qualified for membership during the above period. 

I hereby request a statement of the amount required to establish service credit on my earnings as stated above, which I affirm 

to be a correct and true statement. 

____________________________________________________ 

Signature of General Assembly Member 

August 18, 2006 

_______________________________________ 

Date 




Service Representatives 800/ASK-IMRF


TERMINATION OF IMRF PARTICIPATION 


Please print or type 

Exhibit 6BB 

Member terminations should be submitted online via Employer Access at www.imrf.org 

1. Employer Name 2. Employer Number 


3. Member's Last Name First Middle Initial 

Doe John J. 

4. Social Security Number 5. Last day of participation and/or employment 

(month) (date) (year) 

________________ - ________ - ________________ 

0 0 0 0 0 0 0 0 0 June 10 2009 

COMPLETE EITHER 6A OR 6B: 

6A. Terminated participation only (employment continuing) 

• Member not eligible for separation refund. 

• When employment terminates, submit revised 6.41. 

❏ Change from IMRF qualifying position to nonqualifying 

position 

❏ Change from IMRF to another Illinois public retirement system 

❏ Retire while continue to work in a nonqualifying position 

(Member applied for an IMRF pension but will continue working in a 

position that does not qualify for IMRF.) 

6B. Terminated employment and participation 

❏ Resignation 

❏ Resignation medical 

Member voluntarily resigned for health/medical reasons. Attach 

a copy of the member’s resignation letter or the employer letter 

acknowledging member’s voluntary resignation. 

❏ Dismissal 

❏ Dismissal medical 

Employer terminated member's employment for health/medical 

reasons. 

X❏ Retirement 

❏ Death 

Work Accident_____yes ______no 

If death occurred while a contributing member, the date IMRF 

coverage stopped should be same as the date of death. 

❏ Military Leave 

❏ Term expired (elected officials only) 

________________________________ 

MONTH DATE YEAR 

❏ Other - please explain: ______________________________ 

____________________________________________________ 

7. FINAL EARNINGS AND CONTRIBUTIONS REPORT 

The member’s final paycheck data will be on the Report of Earnings and Contributions for the month of _______________________ 

July 2009 

Wages and contributions can be reported no later than one month after the last day of participation, 

month/year 

e.g., last day of participation is May 15, report wages for May and June but not July. 

8. UNUSED UNPAID SICK DAYS, COMPLETE FOR ALL MEMBERS EXCEPT ELECTED OFFICIALS 

The IMRF member was under an established sick leave plan which is available to all employees or class of employees and the 

member accumulated ________________________ 96 

whole days of unused sick days (do not enter hours) for which the member 

no. of days; if none, enter NONE 

will not be paid. 

9. COMPLETE THIS SECTION IF MEMBER OWES IMRF CONTRIBUTIONS 

The member carries an unpaid contribution balance of $___________________ previously charged to this employer’s account 

under IMRF charge advice number (enter charge advice number): ___________________. Since the member has not reimbursed this 

employer for this amount, please deduct it from the member’s benefit payment and transfer the credit to the employer’s account. 

10. CERTIFICATION BY AUTHORIZED AGENT 

I certify to the Illinois Municipal Retirement Fund Board of Trustees that the above information is true and correct to the best of my 

knowledge and belief. 

AUTHORIZED AGENT signature 

Date 

June 10, 2009 

This form is not an application for any benefit. Benefits must be claimed by the member on the appropriate application. 





www.imrf.org


SUGGESTED FORM OF RESOLUTION TO ALLOW SERVICE CREDIT 

FOR MILITARY LEAVE 


PLEASE NOTE: This form is to be used for military service that interrupted IMRF participation with NO restrictions on amount of service 

credit. 

Use Form 6.62A:for military service that interrupted IMRF participation but WITH restrictions on amount of service credit OR 

for specific military operations involved to receive service credit. 

Use Form 6.63: for military service that interrupted IMRF participation but member did not return to IMRF with 90 days of discharge 

OR was earned prior to IMRF participation. 

ALL BLANK SPACES ON THIS FORM MUST BE FILLED IN. 

PLEASE ENTER 


EXHIBIT 6CC 

9999 

CERTIFICATION 

Clara Clerk 

Clerk 

I, _________________________________________________, the ___________________________________________ 

NAME 

CLERK OR SECRETARY OF THE BOARD 


Prairie 

of the _______________________________________________ of the County of ________________________________, 

EMPLOYER NAME 

RESOLUTION 

Number __________________ 

93-066 

WHEREAS, Article 7 of the Illinois Pension Code (Illinois Revised Statutes, Chap. 108 1 / 2 , Sec. 7-139) provides that 

the governing body of a governmental unit may elect to allow service credit in the Illinois Municipal Retirement Fund to 

members who leave IMRF employment to serve in the armed forces of the United States for all periods of such service, and 

WHEREAS, such allowance of service credit cannot be limited to a specific IMRF member and applies to all 

members who return to active employment under IMRF within 90 days after separation from the armed forces of the United 

States and 

WHEREAS, no service credit can be allowed for any period used in the computation of a pension for service in any 

branch of the armed forces of the United States; 

City Council 

RESOLVED, that the _________________________________________________________________________ 

COUNTY 

State of Illinois, do hereby certify that I am keeper of its books and records and that the foregoing is a true and correct copy of 

a resolution duly adopted by its ___________________________________________________ 

City Council 

at a meeting duly convened 

BOARD, COUNCIL, ETC. 



of ______________________________________________________________________________________________ 

EMPLOYER NAME 

elects to allow service credit to members who have left or leave their employment to serve in the armed forces of the United 

States for an unlimited period of service, provided such member returned to active employment 

and participation in the Illinois Municipal Retirement Fund within 90 days after release from service; 

Clerk 

FURTHER RESOLVED, that the __________________________________________________ shall be directed 

CLERK OR SECRETARY 

to file a certified copy of this resolution with the Board of Trustees of the Illinois Municipal Retirement Fund and that this 

resolution shall remain in full force and effect until modified or rescinded and notice of such modification or rescission has 

been filed with the Board of Trustees of the Illinois Municipal Retirement Fund. This resolution is not limited to a specific 

military operation. 

and held on the _____________ 18th day of _______________________, August 20_____. 07 

SEAL 

_________________________________________ 




Service Representatives 1-800-ASK-IMRF (1-800-275-4673) 


www.imrf.org


SUGGESTED FORM OF RESOLUTION TO ALLOW SERVICE CREDIT 

FOR MILITARY LEAVE 

IMRF Form 6.62A (Rev. 2/04) 

PLEASE NOTE: Use this form for military service that interrupted IMRF participation but WITH restrictions on amount of service 

credit OR for specific military operations involved to receive service credit. 

Use Form 6.62: for military service that interrupted IMRF participation with NO restrictions on amount of service credit 

Use Form 6.63: for military service that interrupted IMRF participation but member did 

not return to IMRF with 90 days of discharge OR was earned prior to PLEASE ENTER 

IMRF participation. 



9 9 9 9 

RESOLUTION 

Number __________________ 

81-1234 

WHEREAS, Article 7 of the Illinois Pension Code (Illinois Revised Statutes, Chap. 108 1 / 2 , Sec. 7-139) provides that 

the governing body of a governmental unit may elect to allow service credit in the Illinois Municipal Retirement Fund to 

members who leave IMRF employment to serve in the armed forces of the United States for all periods of such service, and 


members who return to active employment under IMRF within 90 days after separation from the armed forces of the 

United States and 

WHEREAS, no service credit can be allowed for any period used in the computation of a pension for service in any 

branch of the armed forces of the United States; 


City Council 

CERTIFICATION 

I, _________________________________________________, Clara Clerk 

the ___________________________________________ 

Clerk 

NAME 



Nowhere 


EMPLOYER NAME 

COUNTY 


City Council 

a resolution duly adopted by its ___________________________________________________ at a meeting duly convened 



of ______________________________________________________________________________________________ 


EMPLOYER NAME 

elects to allow service credit to members who have left or leave their employment to serve in the armed forces of the United 

States for _ _ _ _ _ 2 _ _ years _ _ _ _ _ _ _ _ period(s) of service*, provided such member returned to active employment 

AMOUNT OF SERVICE ALLOWABLE 

and participation in the Illinois Municipal Retirement Fund within 90 days after release from service; 

*(The military leaveperiod may be limited to a specific period of time, such as, two years, three years, five years, or may be 

unlimited.) 

Clerk 

FURTHER RESOLVED, that the __________________________________________________ shall be directed 




been filed with the Board of Trustees of the Illinois Municipal Retirement Fund. This resolution is not limited to a specific 

military operation if the governing body wishes. Specify either unlimited (any conflict may be granted the above amount of 

service credit) or list the military operation(s) here: 

unlimited 

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 

SPECIFIY EITHER UNLIMITED OR NAMES OF SPECIFIC MILITARY OPERATIONS 

and held on the _____________ 

18th day of _______________________, August 20_____. 06 

Exhibit 6DD 

SEAL 

_________________________________________ 




IMRF Form 6.62A (Rev. 2/04) Service Representatives 1-800-ASK-IMRF (1-800-275-4673) www.imrf.org


EXHIBIT 6EE 

Suggested Form of Resolution to Allow Service Credit for Military Service 

Member did not return to IMRF within 90 days of discharge OR military service earned prior to participation 

IMRF Form 63A (08/2007) 

PLEASE NOTE: This form is to be used for military service that 

• interrupted IMRF participation but member did not return to IMRF within 90 days of discharge OR 

• was earned prior to IMRF participation 

Use Form 6.62: for military service that interrupted IMRF participation with NO restrictions on amount of service credit 

Use Form 6.62A: for military service that interrupted IMRF participation but WITH restrictions on amount of service credit OR 

specific military operations involved to receive service credit. 

PLEASE ENTER Employer IMRF I.D. Number 


RESOLUTION 

Number __________________ 

81-1234 

WHEREAS, Article 7 of the Illinois Pension Code (40 ILCS 5/7-139) provides that the governing body of a 

governmental unit may elect to allow service credit in the Illinois Municipal Retirement Fund to members who served 

in the armed forces of the United States for all periods of such service prior to their participation in IMRF OR whose 

participation was interrupted by military leave but did not return to IMRF participation within 90 days of discharge, and 


employees who were in active participating status under IMRF on the date this resolution was adopted; 

RESOLVED, that the_______________________________________________________________________________ 

City Council 


9 9 9 9 

of _ __________________________________________________________________________________________ 


EMPLOYER NAME 

elects to allow service credit to members who served in the armed forces of the United States for up to four years of 

service, prior to their participation in the Illinois Municipal Retirement Fund; 

Clerk 

FURTHER RESOLVED, that the _________________________________________ shall be directed to file a 

Clerk or Secretary 

certified copy of this resolution with the Board of Trustees of the Illinois Municipal Retirement Fund and that this 

resolution shall remain in full force and effect until modified or rescinded and notice of such modification or rescission 

has been filed with the Board of Trustees of the Illinois Municipal Retirement Fund. This resolution is not limited to a 

specific military operation. 

CERTIFICATION 

I, _ ________________________________________, Clara Clerk 

the_______________________________________ Clerk 

of the 

NAME 



Nowhere 

_________________________________________________ of the County of ___________________________, 

EMPLOYER NAME 

COUNTY 

State of Illinois, do hereby certify that I am keeper of its books and records and that the foregoing is a true and correct 

copy of a resolution duly adopted by its___________________________________ 

City Council 


and held on the_____________ 18th day of _______________________ August , 20_ ____ 07 . 


SEAL 

IMRF Form 63A (8/2007) 




www.imrf.org 

_ _________________________________ 

CLERK OR SECRETARY OF THE BOARD


Exhibit 6FF 

Page 1 of 2 

A RESOLUTION RELATING TO PARTICIPATION BY ELECTED OFFICIALS 

IN THE ILLINOIS MUNICIPAL RETIREMENT FUND 

IMRF Form 6.64 (Rev. 03/12) (Income tax information can be found on the reverse side of this resolution) 

RESOLUTION 

Number __________________ 

A-5134 

WHEREAS, the ______________________________________________________________________________ 


EMPLOYER NAME 

is a participant in the Illinois Municipal Retirement Fund; and 

WHEREAS, elected officials may participate in the Illinois Municipal Retirement Fund if they are in positions 

normally requiring performance of duty for______________hours 1,000 

or more per year; and 

600 OR 1,000 


0 0 0 0 0 

WHEREAS, this governing body can determine what the normal annual hourly requirements of its elected officials 

are, and should make such determination for the guidance and direction of the Board of Trustees of the Illinois Municipal 

Retirement Fund;* 

NOW THEREFORE BE IT RESOLVED that the _____________________________________________________ 

Anywhere City Council 


finds the following elected positions qualify for membership in IMRF. 

TITLE OF ELECTED POSITION 

DATE POSITION BECAME QUALIFIED 

___________________________________________________________ 

Mayor ________________________________ 

07/01/2013 

___________________________________________________________ ________________________________ 

___________________________________________________________ ________________________________ 

CERTIFICATION 

I, _________________________________________________, Clara Clerk 

the________________________________________ 

Clerk 

NAME 


of the _______________________________________________ 


of the County of __________________________, 

Anywhere 

EMPLOYER NAME 

COUNTY 

State of Illinois, do hereby certify that I am keeper of its books and records and that the foregoing is a true and correct 

copy of a resolution duly adopted by its ________________________________________________at City of Anywhere 

a meeting duly 


convened and held on the____________ 14th of ______________________________________20_____. 

July 13 

DAY MONTH YEAR 

SIGNATURE CLERK OR SECRETARY OF THE BOARD 

* Any person who knowingly makes any false statement or falsifies or permits to be falsified any record of the Illinois 

Municipal Retirement Fund in an attempt to defraud IMRF is guilty of a Class 3 felony (40 ILCS 5/1-135). 





A RESOLUTION RELATING TO PARTICIPATION BY ELECTED OFFICIALS 

IN THE ILLINOIS MUNICIPAL RETIREMENT FUND 

Exhibit 6FF 

Page 2 of 2 

INCOME TAX INFORMATION 

All elected officials eligible to participate in IMRF are considered active participants in 

an employer sponsored retirement plan under the Internal Revenue Code, even if the 

official does not elect to participate in IMRF, and are subject to the IRA 

deductibility limits imposed by law. 

Rescission of this resolution is not definite evidence under IRS regulations that these 

elected positions are no longer covered by an employer sponsored pension plan. 

DOCUMENTATION 

If requested by IMRF, the unit of government should be prepared to produce the 

documentation verifying that the hours required to perform the duties of the 

office meet or exceed the IMRF hourly standard. This documentation would 

include, but not be limited to: office hours, number of meetings held annually, 

preparation time for meetings, conferences, and other corroboration of the time 

required to perform the duties of the office. 

Time spent on-call or otherwise informally available to constituents does not count 

toward the IMRF hourly standard. Additionally, down-time spent travelling to meetings 

does not count toward the IMRF hourly standard. 





RESOLUTION TO ADOPT THE ANNUAL 1,000 HOUR STANDARD 

FOR IMRF PARTICIPATION 


(Can be used only by non-school employers. Cannot be used by school districts or educational cooperatives.) 

RESOLUTION 

Number __________________ 

11-064 

WHEREAS, Section 7-137 of the Illinois Pension Code provides that effective August 12, 2011, non-school employers 

in the Illinois Municipal Retirement Fund may elect to exclude from participation in the Fund persons in positions normally 

requiring performance of duty for less than 1,000 hours per year; and 

WHEREAS, the exclusion may be applicable only to persons first employed in positions under the Fund after the 

adoption of this resolution; and 

WHEREAS, ___________________________________________________________ Anywhere City Council 

is authorized by Section 7-137 

NAME OF BOARD, COUNCIL, ETC. 

of the Illinois Pension Code to adopt such exclusion and it is desirable that it do so; 

BE IT RESOLVED that the __________________________ Anywhere City Council of ___________________________________________ 


NAME OF BOARD, COUNCIL, etc. 

EMPLOYER NAME 

does hereby elect to exclude from participation in the Illinois Municipal Retirement Fund all officials and employees in 

positions normally requiring performance of duty for less than 1,000 hours per year; 

BE IT FURTHER RESOLVED that this exclusion shall apply only to officials and employees who first occupy offices or 

positions under the Fund after adoption of this resolution; 

BE IT FURTHER RESOLVED that the___________________________________________ Clerk 

is authorized and 


directed to file a duly certified copy of this resolution with the Illinois Municipal Retirement Fund. 


0 0 0 0 

Exhibit 6GG 

CERTIFICATION 

I, _________________________________________________ Clara Clerk 

, the____________________________________________ 

Clerk 

NAME 


of the_______________________________________________ City of Anywhere 

of the County of ________________________________ Anywhere 

, 

EMPLOYER NAME 

COUNTY 


a resolution duly adopted by its____________________________________________________ Anywhere City Council 


NAME OF BOARD, COUNCIL, etc. 

and held on the_____________ 18th day of _______________________ August , 20_____ 11 . 

SEAL 

_________________________________________ 






www.imrf.org


CERTIFICATE OF SHERIFF’S LAW ENFORCEMENT SERVICE 


Exhibit 6HH 

Read the instructions before completing this form 

Please print or type 

Purpose of Form 

This Form is only to be used to reclassify service credit 

that was reported in error as regular IMRF service, but 

should have been reported as Sheriff’s Law Enforcement 

Service credit. 

NOTE: Possible Additional Documentation Needed 

If the erroneous reporting continued for more than six (6) 

months, or was for a period of more than one (1) year ago, 

a copy of the member’s deputy sheriff’s oath must be 

filed with this Form. 

member’s first name middle initial last jr., sr., ii, etc. social security number 

__ __ __ __ __ __ __ __ __ 

Richard A. Roe 

_____________ 

111-22-3333 

-__________ -_______________ 

street (mailing) address CITY State zip + 4 telephone no 

( ) 

123 Main Street Anywhere, IL 60000-1234 000 123-9999 

employer name 

employer Imrf i.d. number 

County of Anywhere 9 9 9 9 

statement of service 

May 1, 2007 July 1, 2007 

Service rendered by the member herein from _________________________________ to __________________________________ 

Date D date 

was originally reported to IMRF as regular county employee service but should be recorded as Sheriff’s Law Enforcement Service on 

IMRF accounts. 

CERTIFICATION BY SHERIFF 

I hereby certify that the service period shown as Sheriff’s Law Enforcement Service was rendered in the capacity of a full-time deputy 

sheriff according to the records of my office. 

Signature of Sheriff D date 

August 18, 2007 


The named member was on the County payroll for the period of services shown above. 


August 18, 2007 

date 


I hereby certify that I was employed by the County as a full-time deputy sheriff. 

Signature of Member D date 

August 18, 2007 





www.imrf.org


SUGGESTED RESOLUTION TO INCLUDE COMPENSATION PAID UNDER 

AN INTERNAL REVENUE CODE SECTION 125 PLAN AS IMRF EARNINGS 


RESOLUTION 

Number __________________ 

81-1237 

Exhibit 6II 


9 9 9 9 

WHEREAS, standard member earnings reportable to the Illinois Municipal Retirement Fund do not include 

compensation paid under an Internal Revenue Code section 125 plan or compensation directed into a premium conversion 

plan or flexible spending account; and 

WHEREAS, an IMRF participating unit of government may elect to include in IMRF earnings compensation paid under 

an I.R.C. section 125 plan or compensation directed into a premium conversion plan or flexible spending account by action 

of the governing body; and 

WHEREAS, the 

__________________________________________________________________________ City Council 

of the 

BOARD, COUNCIL, etc. 

_____________________________________________________________________________ 


is authorized to include 

EMPLOYER NAME 

section 125 plan and premium conversion and flexible spending account compensation as earnings reportable to IMRF and 

it is desirable that it do so. 


City Council 


of the 


_____________________________________________________________________________ does hereby elect to 

EMPLOYER NAME 

include as earnings reportable to IMRF compensation paid under an I.R.C. section 125 plan and/or compensation directed 

into a premium conversion plan or flexible spending account effective _______________________________________ Nov. 1, 2006 

. 

EFFECTIVE DATE 

BE IT FURTHER RESOLVED that the ______________________________________ 

Clerk 


to file a duly certified copy of this resolution with the Illinois Municipal Retirement Fund. 

is authorized and directed 

CERTIFICATION 

I, _________________________________________________, Clara Clerk 

the ___________________________________________ 

Clerk 

NAME 


of the _______________________________________________ 


of the County of ________________________________, 

Anywhere 

EMPLOYER NAME 

COUNTY 


a resolution duly adopted by its _____________________________________________ 

City Council 

GOVERNING BODY 



15th day of _______________________, September 20_____. 06 

SEAL 

_________________________________________ 




IMRF Form 6.72 (Rev. 08/03) Service Representatives 800/ASK-IMRF (1-800-275-4673) 

www.imrf.org


SUGGESTED RESOLUTION TO INCLUDE COMPENSATION DIRECTED INTO A 

RETIREMENT HEALTH SAVINGS PLAN AS IMRF EARNINGS 


RESOLUTION 

81-1234 

Number __________________ 

EXHIBIT 6JJ 


9 9 9 9 

WHEREAS, standard member earnings reportable to the Illinois Municipal Retirement Fund may not include certain 

forms of compensation directed into a Retirement Health Savings Plan; and 

WHEREAS, the governing body of an IMRF participating unit of government may elect to include in IMRF earnings all 

compensation directed into a Retirement Health Savings Plan; and 

WHEREAS, the 

__________________________________________________________________________ 

City Council 

of the 


_____________________________________________________________________________ 



EMPLOYER NAME 

compensation directed into a Retirement Health Savings Plan as earnings reportable to IMRF and it is desirable that it do 

so. 


City Council 


of the 

_____________________________________________________________________________ 


does hereby elect to 

EMPLOYER NAME 

include as earnings reportable to IMRF compensation directed into a Retirement Health Savings Plan 

effective __________________________________________ September 1, 2006 

. 


Clerk 

BE IT FURTHER RESOLVED that the___________________________________________ 




CERTIFICATION 

Clara Clerk 

Clerk 

I, _________________________________________________, the ___________________________________________ 

NAME 



Green 


EMPLOYER NAME 

COUNTY 

State of Illinois, do hereby certify that I am keeper of its books and records and that the foregoing is a true and correct copy 

City Council 

of a resolution duly adopted by its __________________________________________ at a meeting duly convened 



18th 

day of _______________________, 

August 

20_____. 

06 

SEAL 





www.imrf.org 

_________________________________________ 



SUGGESTED FORM OF RESOLUTION TO 

ADOPT EARLY RETIREMENT INCENTIVE 


PLEASE ENTER 


0 0 0 0 0 

See notes on back regarding Limitations on Frequency, ERI Cost Estimates, and Dissolutions. 

RESOLUTION Number __________________ 

B-1234 

WHEREAS, Section 7-141.1 of the Illinois Pension Code provides that a participating employer may elect to adopt an early retirement 

incentive program offered by the Illinois Municipal Retirement Fund by adopting a resolution or ordinance; and 

WHEREAS, the goal of adopting an early retirement program is to realize a substantial savings in personnel costs by offering early 

retirement incentives to employees who have accumulated many years of service credit; and 

WHEREAS, IMRF has prepared an actuarial estimate of the cost of an early retirement incentive program for 

_________________________________________________________ City of Anywhere 

and the additional liability created by the early retirement incentive 

EMPLOYER NAME 

is estimated to be $ __________________; and the 10-year amortization cost is estimated to be $ _________________. 

200,000 125,000 


Exhibit 6KK 

Page 1 of 2 

WHEREAS, the _____________________________has reviewed the cost estimate and determined that the adoption of an early 


retirement incentive is in the best interests of the _____________________________________; City of Anywhere 

therefore be it 

EMPLOYER NAME 

RESOLVED by the ________________________of_________________________________________________that: 


City Anywhere 

BOARD, COUNCIL, . ETC. 

EMPLOYER NAME 

(1) The _________________________________________________ City of Anywhere 

does hereby adopt the Illinois Municipal Retirement Fund 

EMPLOYER NAME 

early retirement incentive program as provided in Section 7-141.1 of the Illinois Pension Code. The early retirement incentive program shall 

take effect on ________________________. 

08/31/2013 

DATE 

(2) In order to help achieve a true cost savings, an employee who retires under the early retirement incentive program shall lose those 

incentives if he or she later accepts employment with any IMRF employer in any position. (Exception: employee can hold an elected position if 

he/she chooses to not participate in IMRF and the pension is not based on any service earned in that position during any term of office.) 

(3) In order to utilize an early retirement incentive as a budgeting tool, the____________________________________ 


EMPLOYER NAME 

will use its best efforts either to limit the number of retiring employees replaced or to limit the salaries paid to the replacement employees. 

(4) The effective date of each employee’s retirement under this early retirement incentive program shall be set by 

____________________________________ City of Anywhere 

and shall be no earlier than the effective date of the program and no later than one year after 

EMPLOYER NAME 

that effective date; except that the employee may require that the retirement date set by the employer be no later than the June 30 next 

occurring after the effective date of the program and no earlier than the date upon which the employee qualifies for retirement. 

(5) To be eligible for the early retirement incentive under this Section, the employee must have attained age 50 and have at least 20 

years of creditable service by his or her retirement date; and 

(6) As of the date of the adoption of this Resolution, the ___________________________________ Anywhere City Council 

is ( ) is not ( X) aware of the 


pending dissolution of ____________________________________. 


EMPLOYER NAME 

(Note: Failure to disclose a potential dissolution shall void this Resolution. If the Board, Council, etc. is aware of the 

pending dissolution of the IMRF employer, then the successor unit(s) of local government must approve the adoption of the early 

retirement incentive in order for this Resolution to be effective. If there is no successor, submit your resolution for approval from 

the IMRF Board of Trustees.) 

(7) The ____________________________ Clerk 

shall promptly file a certified copy of this resolution (ordinance) with the 


Board of Trustees of the Illinois Municipal Retirement Fund. 

CERTIFICATION 

I, __________________________________________the Clara Clerk 

___________________________________of Clerk 

the 

NAME 


________________________________________________________of City Anywhere 

the County of __________________, Anywhere State of Illinois, do hereby 

EMPLOYER NAME 

COUNTY 

certify that I am the keeper of the books and records of the _________________________________ City of Anywhere 

and that the foregoing is a true and 

EMPLOYER NAME 

correct copy of a resolution (ordinance) ______________________________ 1234567 

duly adopted by the_______________________at Anywhere City Council a meeting 

ORDINANCE 


duly convened and held on the 16th ____ day of _____________, July 20______. 13 

If applicable, I further certify that this Resolution has been submitted to the successor unit(s) of local government and that said 

unit(s) of local government has/have adopted a resolution approving the adoption of the early retirement incentive for 

_______________________________________________________________. 


EMPLOYER NAME 

A copy of the approval resolution is attached hereto. 

SEAL 





IMRF Form 6.77 (Rev. 04/2013) www.imrf.org 

Page 1 of 2

Limitation on Frequency 

• Employers may not adopt an Early Retirement Incentive (ERI) more frequently than once every five 

years after the close of a prior ERI. 

Exhibit 6KK 

Page 2 of 2 

• An ERI resolution adopting a program earlier than five years after the close of a prior ERI shall not be 

given effect by IMRF. 

• This requirement applies to ERI programs effective December 31, 2013, and thereafter. 

ERI cost estimates 

• When an employer submits the ERI resolution to IMRF, it should include a copy of the cost estimate for 

the period of the adopted ERI. 

• Contact your IMRF Field Representative to request a cost estimate. Your local Field Representative 

will be able to calculate the annual increased pension costs. The cost estimate will be completed at no 

charge to the employer. 

• If an employer submits the ERI resolution without a cost estimate: 

— IMRF will not implement the program, and 

— The employer will need to both conduct the cost estimate and adopt a second resolution. 

Dissolutions 

• If an employer is dissolving and its IMRF assets and liabilities will be transferred to: 

One successor unit of government—the dissolving employer must provide the ERI Cost Study to 

the successor, and the successor must also approve the ERI. A copy of the successor unit’s 

resolution approving the ERI must be available to IMRF upon request. 

More than one successor unit of government—the dissolving employer must provide the ERI Cost 

Study to each successor, and a majority of the successors must approve the ERI. Copies of the 

successor units’ resolutions approving the ERI must be available to IMRF upon request. 

No successor unit of government and the law does not specify responsibility for the IMRF assets 

and obligations—the IMRF Board of Trustees must approve the ERI. 

• If a dissolving employer submits the ERI resolution without approval by successor unit(s) of local 

government or without a request for IMRF Board of Trustee approval when no successors exist, IMRF 

will not implement the ERI program. 

• If IMRF is unaware that these requirements were not met and pays an ERI enhanced pension to a 

member who: 

—Retired at age 55 or older under Regular Tier 1 (age 50 for SLEP and SLEP ECO) or at age 62 or 

older under Regular Tier 2, the member will lose the ERI enhancements and be required to pay 

IMRF the difference between the ERI enhanced pension and the pension he or she would have 

received without the ERI—less the amount he or she paid for the ERI. 

—Retired at less than age 55 under Regular Tier 1 or less than age 62 under Regular Tier 2, the 

member will be required to repay IMRF for all pension payments received—less the amount paid for 

the ERI. 




www.imrf.org 


SUGGESTED FORM OF RESOLUTION TO ADOPT AMORTIZATION PERIOD 

FOR IMRF EARLY RETIREMENT INCENTIVE 


RESOLUTION 

Number __________________ 

81-1235 

EXHIBIT 6LL 

PLEASE ENTER Employer IMRF I.D. 

Number 

9 9 9 9 

August 18, 2006 

City Council 

WHEREAS, on __________________________ the ________________________________ of 

DATE 


City of Anywhere 81-1234 

______________________________________ adopted Resolution (Ordinance) No ______ which established an 

EMPLOYER NAME 

early retirement incentive (incentive) through the Illinois Municipal Retirement Fund for its employees; and, 

WHEREAS, Section 7-141.1 of the Illinois Pension Code provides that a participating employer may select an 

amortization period for the actuarial costs of the incentive which may be no greater than 10 years; and, 


WHEREAS, _____________________________________________ is prohibited from adopting a subsequent 

EMPLOYER NAME 

incentive until the actuarial costs of the previous programs are paid. 

City Council 


RESOLVED (ORDAINED) by the ________________________ of ____________________________________that 


EMPLOYER NAME 


the _________________________________________ does hereby request the Illinois Municipal Retirement Fund to 

EMPLOYER NAME 

amortize the cost of the incentive over a period of ______ 

5 

years. 

NUMBER 

CERTIFICATION 

I,_____________________________________________, Clara Clerk 

the __________________________________ Clerk 

of the 

NAME 


________________________________________________ 


of the County of _______________________, 

Green 

State of Illinois, 

EMPLOYER NAME 

COUNTY 

do hereby certify that I am the keeper of the books and records of the _______________________________________ City of Anywhere and 

EMPLOYER NAME 

that the foregoing is a true and correct copy of a resolution (ordinance) duly adopted by the________________________ City Council at 

a 


meeting duly convened and held on the _________ 18th day of ___________________, August 20______. 06 

SEAL 

__________________________________ 





Service Representatives 1-800-ASK-IMRF 

www.imrf.org


Exhibit MM 

Form 6.79 has been DISCONTINUED.


Exhibit 6 NN 

Form 6.80 has been DISCONTINUED


SUGGESTED FORM OF RESOLUTION TO ALLOW MORE THAN 50 MONTHS 

OF RETROACTIVE SERVICE CREDIT FOR ELECTED OFFICIALS 


EXHIBIT 6OO 

PLEASE ENTER Employer IMRF I.D. 

Number 

9 9 9 9 

RESOLUTION 

81-1234 

Number __________________ 

WHEREAS, Article 7 of the Pension Code (Illinois Compiled Statutes, 40 ILCS 5/7-139 (a) (7)) provides that governing 

bodies of IMRF employers with compensated elected officials may resolve to allow eligible former, current, and future 

elected officials to purchase service credit in the Illinois Municipal Retirement Fund in an amount that exceeds 50 months of 

retroactive service, and 

WHEREAS, such an allowance is limited to time periods during which the elected official qualified for IMRF 

participation, and 

WHEREAS, the governing body must adopt this resolution before December 31, 2001; 

City Council 



of ______________________________________________________________________________________________ 


EMPLOYER NAME 

shall allow the purchase of retroactive service credit for eligible elected officials in excess of 50 months. 

FURTHER RESOLVED, that the __________________________________________________ 

Clerk 

shall be directed 




been filed with the IMRF Board of Trustees. 

CERTIFICATION 

Clara Clerk 

Clerk 

I, _________________________________________________, the ___________________________________________ 

NAME 



Green 


EMPLOYER NAME 

COUNTY 


City Council 

a resolution duly adopted by its ________________________________________________ at a meeting duly convened 

BOARD 

18th August 01 

and held on the _____________ day of _______________________, 20_____. 

SEAL 

________________________________________ 




IMRF Form 6.81 (8/2001) Service Representatives 800/ASK-IMRF (1-800-275-4673)


SUGGESTED FORM OF RESOLUTION TO REVOKE 

ALTERNATIVE BENEFIT PROGRAM FOR COUNTY OFFICERS 


RESOLUTION 

Number __________________ 

81-1247 

EXHIBIT 6PP 


9 9 9 9 

WHEREAS, on __________________________________________ November 15,2008 

the County Board of 

DATE 

____________________________ 

Anywhere 

NAME OF COUNTY 

adopted Resolution (Ordinance) No. __________ 81-1234 which established an alternative benefit program for county 

NUMBER 

officers as provided for in Section 7-145.1 of the Illinois Pension Code; and 

WHEREAS, P.A. 91-0685 allows a county board to revoke the alternative benefit program for county officers who have 

not enrolled in the alternative benefit program before the date of the revocation; therefore be it 

RESOLVED by the County Board of ______________________________ Anywhere 

that: 


(1) The alternative benefit program for county officers in ________________________County Anywhere 

as provided in 


sections 7-145.1 and 7-145.2 of the Illinois Pension Code is hereby revoked. 

(2) This revocation applies to all county officers of ________________________ Anywhere 

County who have not enrolled in 


the alternative benefit program before ___________________________________. 


REVOCATION EFFECTIVE DATE 

(3) The __________________________of Clerk 

the County Board of ____________________ Anywhere County shall promptly file 



a copy of this resolution (ordinance) with the Board of Trustees of the Illinois Municipal Retirement Fund. 

CERTIFICATION 

I, __________________________________________the Clark Clerk 

___________________________________of Clerk 

the 

NAME 


________________________________________________________of Anywhere 

the County of __________________, Anywhere State of 

EMPLOYER NAME 

COUNTY 

Illinois, do hereby certify that I am the keeper of the books and records of the _________________________________ 

County of Anywhere 

EMPLOYER NAME 

Board 

and that the foregoing is a true and correct copy of a resolution duly adopted by the____________________________at a 

BOARD 

meeting duly convened and held on the 15th ____ day of _________, November 20 ___. 06 

SEAL 

_________________________________________ 





Service Representatives 1-800-ASK-IMRF (1-800-275-4673 7:30 A.M. to 5:30 P.M.)


SUGGESTED FORM OF RESOLUTION TO REQUIRE ADDITIONAL EXHIBIT 6QQ 

MEMBER CONTRIBUTIONS FOR PAST SERVICE CONVERTED TO 

THE ALTERNATIVE BENEFIT PROGRAM FOR COUNTY OFFICERS 



9 9 9 9 

RESOLUTION 

Number __________________ 

81-1235 

WHEREAS, Section 7-145.1 of the Illinois Pension Code provides that a County Board may require additional member 

contributions for past service converted to the alternative benefit program for county officers by adopting an irrevocable 

resolution or ordinance; 


THEREFORE IT IS RESOLVED by the County Board of ____________________________that additional 

(COUNTY NAME) 

member contributions are required to establish service credit in the alternative plan for elected county officers for past 

service as a county officer. These additional contributions shall be the actuarial present value of the additional cost of this 

past service, in an amount to be determined by the Illinois Municipal Retirement Fund Board of Trustees. The requirement 

for additional member contributions shall be effective as of the date of this resolution and shall be irrevocable. 

Clerk 

The ___________________________________shall promptly file a certified copy of this resolution (ordinance) 


with the Board of Trustees of the Illinois Municipal Retirement Fund. 

CERTIFICATION 

I, __________________________________________the Clark Clerk 

___________________________________of Clerk 

the 

NAME 


________________________________________________________of County 

the County of __________________, Anywhere State of 

EMPLOYER NAME 

COUNTY 



EMPLOYER NAME 

and that the foregoing is a true and correct copy of a resolution duly adopted by the____________________________at Board 

a 

BOARD 

meeting duly convened and held on the 18th ____ day of _________, August 20 ___. 06 

SEAL 

_________________________________________ 





Service Representatives 1-800-ASK-IMRF (1-800-275-4673 7:30 A.M. to 5:30 P.M.)


SUGGESTED RESOLUTION (ORDINANCE) FOR EMPLOYER PICK-UP 

(PAYMENT) OF MEMBER CONTRIBUTIONS REQUIRED FOR PURCHASE 

OF EXTRA SERVICE UNDER THE IMRF EARLY RETIREMENT INCENTIVE 


RESOLUTION (ORDINANCE) 

Number __________________ 

9999 

WHEREAS, Section 7-141.1 of the Illinois Pension Code allows certain IMRF members to purchase additional service 

credit in order to induce those members to retire early; and 

WHEREAS, Section 7-141.1 of the Illinois Pension Code requires a member contribution for the early retirement service 

credit; and 

WHEREAS, Section 414(a) of the Internal Revenue Code provides that contributions designated as member 

contributions but picked-up by the employer shall be excluded from taxable income until distributed as a refund, annuity or 

death benefit; and 

WHEREAS, it is desirable that the member contributions required by the IMRF early retirement incentive be paid by the 

employer. 

NOW THEREFORE BE IT RESOLVED (ORDAINED) by the _____________________________________________ 

City Council 

NAME OF GOVERNING BODY (BOARD OF COMMISSIONERS, ETC.) 

of the 


_______________________________________________________ that the member contributions required by the IMRF early 

NAME OF UNIT OF GOVERNMENT 

retirement incentive be paid by the ____________________________________ City Council 

on behalf of all its employees who retire 


under the IMRF early retirement incentive. 

BE IT FURTHER RESOLVED (ORDAINED) that the payment shall be made by a reduction in earnings payments to 

those employees. 

BE IT FURTHER RESOLVED (ORDAINED) that the pick-up of member contributions shall be effective for all employees 

of the ____________________________________ City of Anywhere 

who retire under the IMRF early retirement incentive adopted by 


City of Anywhere September 1, 2006 

the____________________________________ on ____________________________________. 


DATE OF ERI RESOLUTION (ORDINANCE) 

Exhibit 6RR 

CERTIFICATION 

I, __________________________________________the Clara Clerk 

___________________________________of Clerk 

the 

NAME 


________________________________________________________of City Anywhere 

the County of __________________, Nowhere 

State of 

EMPLOYER 

COUNTY 



EMPLOYER NAME 

and that the foregoing is a true and correct copy of resolution (ordinance) number ______________________________ 9999 

duly 

RESOLUTION (ORDINANCE) NUMBER 

adopted by the ________________________at City Council a meeting duly convened and held on the 18th ____ day of _______, Aug. 20___. 06 

BOARD, COUNCIL, ETC.. 

SEAL 

_________________________________________ 


Form 6.85 (12/2005) 



Service Representatives 800/ASK-IMRF


SUGGESTED FORM OF RESOLUTION TO ADOPT THE IMRF SHERIFF’S LAW 

ENFORCEMENT PERSONNEL PROGRAM FOR AIRPORT POLICE 


CERTIFICATION 

I, ______________________________________________, being the duly appointed _______________________________of the 

NAME 


________________________________________________________, State of Illinois, do hereby certify that I am the keeper of the 

NAME OF GOVERNMENTAL UNIT 

books and records of the aforesaid political entity and that the foregoing is a true and correct copy of a resolution adopted by the 

________________________________________________________ at a meeting duly convened and held on the _______ day of 

NAME OF GOVERNING BODY 

DATE 

_______________________, 20 _____. 

MONTH 

YY 

RESOLUTION 

Number __________________ 

PLEASE ENTER 


____________________________ 

WHEREAS, Section 7-109.3 of the Illinois Pension Code defines a sheriff law enforcement employee to include persons not 

eligible to participate in Article 3 of the Illinois Pension Code who are employed on a full-time basis to perform police duties at an 

airport; and, 

WHEREAS, ___________________________________________, participates in the Illinois Municipal Retirement Fund; and, 

NAME OF ENTITY 

WHEREAS, the _____________________________________________ is authorized by Section 7-109.3 of the Illinois 


Pension Code to approve sheriff’s law enforcement employee status for its airport police employees by adoption of an affirmative, 

irrevocable resolution. 

Anywhere Airport Authority 

NOW, THEREFORE, BE IT RESOLVED by the ______________________________________________________________ 


of the ______________________________________________ as follows: 

NAME OF ENTITY 

. 

Board 


9 9 9 9 

(a) All full-time airport police employees not eligible to participate in Article 3 of the Illinois Pension Code shall participate in the 

Illinois Municipal Retirement Fund as sheriff law enforcment employees. 

(b) Such participation shall commence on the first day of ___________________________, 20 _____. 

MONTH 

YY 

Clara Clerk 


Board 

March 13 

81 - 1734 

Board 

June 13 

Clerk 

EXHIBIT 6SS 

7th 

SEAL 






www.imrf.org


conversion of regular service credit to 

SLEP service credit 



EXHIBIT 6TT 

Page 1 of 3 

Avoid delays—read the instructions below and on back before completing this form 

Requirements for Converting Service Credit 

If you held a SLEP-qualifying position between 7/1/04 

and 8/8/11, you can convert up to 10 years earnings and 

contributions which were previously reported to 

IMRF under the Regular plan to service credit under the 

SLEP plan. 

1. This form must be received while you are currently 

participating in IMRF under the SLEP plan. 

2. Periods of participation to be converted 

If you you held a SLEP-qualifying position between 

7/1/04 and 8/8/11, you can convert up to 10 years 

of earnings and contributions, which were previously 

reported to IMRF under the Regular plan, to service 

credit under the SLEP plan. 

currently on deposit with IMRF. If you took a refund of 

your service, see item number 4. 

4. If you took a refund of member contributions and 

forfeited the service credit, the service can be reinstated 

and converted to SLEP simultaneously using IMRF 

Form 6.03, “Application for Reinstatement of Service 

Credit.” 

5. If you qualify for Omitted Service (any time you 

worked for an IMRF employer, in a qualifying position, 

but were not reported), you would first submit IMRF 

Form 6.05 “Omitted Service Verification,” purchase that 

service as Regular service, and THEN complete this 

Form 6.09 to convert it to SLEP service. 

3. Earnings and contributions for the periods listed on 

this form were reported to IMRF under the Regular 

IMRF plan, and the service (your contributions) is 


1. Member’s information 





2. Employer information 


How to pay for service 


For each month of service converted to SLEP, you 

would pay IMRF an additional: 

• 3% contributions on Regular IMRF earnings 

converted to SLEP, the required employer 

contributions, plus interest. 

Interest is calculated on the contributions from the earliest 

year that is being converted through December 31 of the 

year preceding the current year. 





Option I is the Lump Sum Payment Plan. 


total cost with a single payment and purchase all the 

eligible service you choose to purchase at one time. 

You can purchase a portion, all, or none of the past 

service listed on your payment schedule. 

Option 2 is the Unit Payment Plan. 


or more months of service at a time. You may pay as 

often as you like, buying back credit from the most 

recent month to the earliest month of eligible service. 

However, you may not buy more months than 



“How to pay...” continued on back

“How to pay...” continued from front 

EXHIBIT 6TT 

Page 2 of 3 

If you want to know how converting your service will 

affect your pension, you should wait until you receive 

the Past Service Payment Schedule. Then you can 

call 1-800-ASK-IMRF (1-800-275-4673) for a pension 

estimate before you determine how many months of 

service to convert. 

How purchasing the service will affect your pension 


which you can find online at www.imrf.org, or call 

1-800-ASK-IMRF to request a copy. The section titled “Is 

it worth it to purchase service” provides a detailed 

description of how to calculate the impact of service on 

your pension. 

If you plan to retire under the Reciprocal Act 



reciprocal pension system. If you have less than 12 

months of service with any single reciprocal retirement 

system, that service will not be counted in the calculation 

of your reciprocal pension. Exception: A former teacher 

aide who transferred to a position covered by the Teachers’ 




covered by the Act is available on the IMRF website, www. 

imrf.org, or by request from an IMRF Member Service 

Representative at 1-800-ASK-IMRF (1-800-275-4673). 

Local police and fire pension funds are not covered by the 

Act. 

Reciprocal service may not be added in the calculation 

of a SLEP pension. 


conversion of regular service credit TO 

SLEP service credit 



EXHIBIT 6TT 

Page 3 of 3 

Avoid delays—read the instructions on the previous pages before completing this form 

Please print or type – use black ink 

member’s first name middle initial last jr., sr., ii, etc. social security number 

__ __ __ __ __ __ __ __ __ 

John J. Doe 000 - 00 - 0000 

street (mailing) ADDRESS CITY, state and zip + 4 

123 Elm Street Anywhere, IL 60000 

DAYTIME TELEPHONE NUMBER HOME TELEPHONE NUMBER optional: anticipated retirement date 

( 000 ) 000 - 0000 ( 000 ) 000 - 0000 

name of current imrf employer 

IMRF Employer i.d. number 


current position 

Deputy 

period(s) of participation (regular service credit) to be converted 

Enter the periods of employment you wish to convert to SLEP service credit. You must have held a SLEP-qualifying position 

between 7/1/04 to 8/8/11 to qualify for conversion. A maximum of 10 years can be converted to SLEP. 

name of IMRF employer(s) 

TITLE or position 

Coverage Period (mm/dd/YYYY to mm/dd/yyyy) 

Town of Nowhere Dispatcher 7/15/2005 - 4/15/2006 

CERTIFICATION BY MEMBER: I hereby certify that, 

• I am currently participating in the Sheriff’s Law Enforcement Personnel (SLEP) Plan. 

• I held a SLEP-qualifying position between 7/1/04 and 8/8/11. 

• If I convert (purchase) more years of service than I need, I will not be able to receive a refund. 

• If I convert (purchase) fewer years of service than I need and I have stopped participating in IMRF, I will be allowed to make a 

one-time conversion (purchase) of the additional service credit. 

• I request that you provide me with the cost to convert this service credit so it may be considered SLEP service credit. 

If you are concerned about overpaying (converting more service than you need), you can purchase (convert) most but not all of 

the service indicated on the Payment Schedule you will receive, and request a precise pension estimate when you near your 

termination (retirement) date. 

x 


May 15, 2006 

Date 



Member Services Representatives 1-800-ASK-IMRF (1-800-275-4673) 7:30 a.m. to 5:30 p.m. 


www.imrf.org


IMRF Transfer to state employees RETIREMENT SYSTEM 

EXHIBIT 6WW 

(SERS Alternative Retirement Formula Plan) 

Under Public Act 95-0530 


SERS Information 

Telephone ( 000 )___________________________________ 123-4567 Alternate Phone ( 000 )_ ______________________ 

789-1234 

Contact Person _ ____________________________________ Henry Roe 

Title _ ___________________________________________ 

Administrator 

E-mail Address _ _____________________________________________________________________________________ 

Hroe@sers.org 

Indicate how SERS wishes to receive 

the member and employer credits: XX n Check n Automated Clearing House (ACH) transfer 

If ACH, complete the following: 

ABA/Routing Transit # ____________________________________________ n Checking n Savings 

Bank Account # ____________________________________________________________________________________ 

Your Information 

Full Name ________________________________________________________________________________________ 

Doe John J 

Last First M.I. 

Current SERS position: 

n X State policeman 

n Conservation police officer 

n Other_______________________________ 

n Controlled substance inspector 

n Investigator for Secretary of State 

789-10-3456 johndoe@verizon.com 

Social Security # _ _________________________ Email Address: _________________________________________ 

Home Address ____________________________________________________________________________________ 

456 Greem Street 333 Anywhere IL 60000 

Street Address Apt. # City, State, Zip 

Telephone ( 000 )______________________________________ 123 3333 Alternate Phone ( 000 )____________________ 

456-3214 

Forfeited/Refunded IMRF Service Credit 

Do you have any refunded IMRF SLEP service credit you want to reinstate and transfer to SERS n X No n Yes 

If yes, complete the following: 

If you previously used a different name with IMRF, please indicate:____________________________________________ 

Year(s) in which you received your refund check(s):________________________________________________________ 

IMRF Coverage Period(s) _ ___________________________________________________________________________ 

Please note: If you reinstate your forfeited IMRF SLEP service credit at the reduced interest rate of 6%, you must transfer 

all of the service to the SERS Alternative Formula Annuity Plan. 

___________________________________________________ September _____________________________________ 

10, 2007 

SERS Member Signature 

Date 

Mail this form to IMRF, 2211 York Road, Suite 500, Oak Brook IL 60523 or fax to 630-706-4289 

For IMRF Use Only: IMRF PARTICIPATION INFORMATION IMRF FEIN # 36-6001368 

Coverage Period 

Transferred 

Service 

Amount Yrs. Mos. 

Coverage Period 

Transferred 

Service 

Amount Yrs. Mos. 

Total Transfer 

Amount $ 

Total Member 

Contributions $ 


Tax-deferred 

Portion $ 

Total Member 

Interest $ 

Previously-taxed 

Portion $ 

Employer Contributions 

and interest $


Suggested Resolution to Include Taxable Allowances 

as IMRF Earnings 


CERTIFICATION 

RESOLUTION 

1234-AB 

Number ________________ 

WHEREAS, standard member earnings reportable to the Illinois Municipal Retirement Fund do not include expense 

allowances; and 

WHEREAS, the governing body of an IMRF participating unit of government may elect to include in IMRF earnings 

taxable expense allowances; and 

WHEREAS, the __________________________________________________________________________ Anywhere Board 

of the 


_____________________________________________________________________________ City of Anywhere 


EMPLOYER NAME 

taxable expense allowances as earnings reportable to IMRF and it is desirable that it do so. 

NOW THEREFORE BE IT RESOLVED that the ____________________________________________________ Anywhere Board 

of the 


________________________________________________________________________________does City of Anywhere 

hereby elect to 

EMPLOYER NAME 

include as earnings reportable to IMRF the following taxable expense allowances effective 11/21/2013 

___________________________: 


___________________________________________________________________________________________________ 

Example 1 

___________________________________________________________________________________________________ 

Example 2 

___________________________________________________________________________________________________ 

___________________________________________________________________________________________________ 

___________________________________________________________________________________________________ 

___________________________________________________________________________________________________ 

BE IT FURTHER RESOLVED that _______________________________________________ Clara Clerk 


CLERK OF SECRETARY OF THE BOARD 



0 0 0 0 0 

I, _________________________________________________ Clara Clerk 

, the____________________________________________ 

Clerk 

NAME 


of the_______________________________________________ City of Anywhere 

of the County of ________________________________ Everywhere 

, 

EMPLOYER NAME 

COUNTY 

State of Illinois, do hereby certify that I am keeper of its books and records and that the foregoing is a true and correct copy 

of a resolution duly adopted by its __________________________________________ Board 



and held on the_____________ 21st 

day of _______________________ November 

, 20_____ 13 . 

Exhibit 3C 

SEAL 





www.imrf.org 

_________________________________________ 



SUGGESTED FORM OF RESOLUTION TO DESIGNATE 

THE REGIONAL OFFICE OF EDUCATION AS AN IMRF 

REPORTING ENTITY DISTINCT FROM THE COUNTY 


Exhibit 6YY 


RESOLUTION 

00-0000 

Number __________________ 

WHEREAS, the provisions of 40 ILCS 5/7-132.2(b) permit the Board of Trustees of the Illinois Municipal Retirement 

Fund to designate any participating Educational Service Region as a separate reporting entity, distinct from the County, at 

the request of the County; and 

WHEREAS, the County Board of __________________________ Anywhere 

has determined that it is desirable to designate the 

name of county 

County’s Regional Office of Education as an IMRF reporting entity, distinct from the County. 

THEREFORE IT IS RESOLVED by the County Board of _________________________________ Anywhere 

as follows: 

(1) That the Board of Trustees of the Illinois Municipal Retirement fund be and hereby is requested to designate the 

Regional Office of Education of _____________________________ Anywhere 

as a separate reporting entity, distinct from the County. 



(2) That this resolution shall become effective immediately upon its adoption and a certified copy thereof be forwarded 

to the Board of Trustees of the Illinois Municipal Retirement Fund. 

CERTIFICATION 

Anywhere 

Clara Clerk 

Clerk 

I, __________________________________________the ___________________________________of the 

name 

clerk or secretary 

Board of the County of ________________________________, Anywhere 

State of Illinois, do hereby certify that I am the keeper of the 


books and records of the County of ___________________________________and Anywhere 

that the foregoing is a true and correct 


copy of a resolution duly adopted by the ___________________________________ Anywhere 

County Board at a meeting duly 


convened and held on the _______ 8th day of ______________________, April 20 10 ____. 

SEAL 

_ ________________________________________ 




Member Services Representatives 1-800-ASK-IMRF (1-800-275-4673 7:30 a.m. to 5:30 p.m.) 

IMRF Form 6.88 (10/08)


REQUEST FOR REFUND OF 

VOLUNTARY ADDITIONAL CONTRIBUTIONS (VAC) 

IMRF Form VARF (11/2013) 

Exhibit 6ZZ 

NOTE: Effective February 1, 2014, if a member continues working for his or her IMRF employer and wishes to take a 

refund of VAC, only the VAC, without the interest, can be withdrawn. The interest must stay on deposit until the member 

stops working for his or her IMRF employer. The interest will continue to earn interest until the member withdraws it after 

terminating employment. At retirement, a member may annuitize his or her VAC if the account balance is $4,500 or more. 


LAST NAME FIRST NAME MIDDLE INITIAL JR., SR., II, ETC. SOCIAL SECURITY NUMBER 

Rowe James _______ 0 0 0 - ______ 0 0 - 0 _______ 0 0 0 

HOME STREET (MAILING) ADDRESS 

SECTION 2 — STANDARD VAC PROCESSING INFORMATION 

• If there is a portion of your refund eligible for a rollover, IMRF will send you the required notifications and forms 

before your claim is approved. 

• This is NOT a regular savings account so there may be a delay in processing your request. IMRF will not process 

your VAC refund until all contributions for the period being refunded have been reported. 

Examples: 

• Refund through 12/31 of last year will not be processed until all VA Contributions, including the month of 

December, have been reported to IMRF (typically received by mid-January.) 

• Refund through date chosen will not be processed until IMRF has received all VA Contributions through 

the date specified on this application (typically received by mid-month following the final date of the plan.) 

CHOOSE OPTION A OR B BELOW AND PROVIDE APPROPRIATE SIGNATURE(S) 

MEMBER SIGNATURE (WRITE; DO NOT PRINT) 


IMRF Form VARF (11/2013) 



OPTION B - CURRENT-YEAR REFUND WITH SUSPENSION OF VA CONTRIBUTIONS 

Through ________________________________, I request a refund of my Voluntary Additional 

DATE OF LAST PAYCHECK WITH VAC (MM/DD/YYYY) 

Contributions and interest, including VAC made in the current year. I acknowledge that I will not 

be allowed to enroll in Voluntary Additional Contributions again until January of next year. 


X 

SIGNATURE OF AUTHORIZED AGENT (REQUIRED TO STOP VA CONTRIBUTIONS) 

X 


123 Oak Street Anywhere, IL 60000 

COUNTY DATE OF BIRTH (MM/DD/YYYY) DAYTIME TELEPHONE NUMBER (w/ Area Code) 

Everywhere 09/06/1956 ( 0 0 0 ) 0 0 0 - 0 0 0 0 

YOUR EMPLOYER (Required) EMPLOYER NO. (If known) HOME TELEPHONE NUMBER (w/ Area Code) 

Village of Anywhere 0 0 0 0 0 ( 0 0 0 ) 0 0 0 - 0 0 0 0 

OPTION A - PREVIOUS-YEAR REFUND WITH CONTINUED VA CONTRIBUTIONS 

X 

X 

I request a refund of my Voluntary Additional Contributions and interest through December 31 of 

the previous year. I wish to continue making Voluntary Additional Contributions in the 

current year. 

11/21/2013 





Member Services Representatives 1-800-ASK-IMRF (1-800-275-4673) Fax: (630) 706-4508 

www.imrf.org


EXHIBIT 6AAA 

SUGGESTED FORM OF RESOLUTION TO ADOPT THE IMRF SHERIFF’S 

LAW ENFORCEMENT PERSONNEL PROGRAM FOR LAW ENFORCEMENT 

OFFICERS OF A FOREST PRESERVE DISTRICT 


RESOLUTION 

Number __________________ 

PLEASE ENTER 


____________________________ 

WHEREAS, Section 7-109.3 of the Illinois Pension Code defines a sheriff law enforcement employee to include persons 

employed by a Forest Preserve District on a full-time basis as law enforcement officers; and, 

Anywhere Forest Preserve 

WHEREAS, ___________________________________________, participates in the Illinois Municipal Retirement Fund; and, 

NAME OF FOREST PRESERVE DISTRICT 

WHEREAS, the Board of Commissioners of the ________________________________________ is authorized by Section 


7.109-3 of the Illinois Pension Code to approve sheriff’s law enforcement status for its full-time law enforcement employees by 

adoption of an affirmative, irrevocable resolution. 

81 - 1734 


9 9 9 9 

that: 


NOW, THEREFORE, BE IT RESOLVED by the Board of Commissioners of the ____________________________________ 


. 

All full-time law enforcement employees shall participate in the Illinois Municipal Retirement Fund as sheriff law enforcement 

employees for all service in that capacity. 

CERTIFICATION 

Clara Clerk 

I, ______________________________________________, being the duly appointed _______________________________of the 

NAME 



Clerk 

________________________________________________________, State of Illinois, do hereby certify that I am the keeper of the 


books and records of the aforesaid political entity and that the foregoing is a true and correct copy of a resolution adopted by the by 

21st June 

13 

the Board of Commissioners at a meeting duly convened and held on the _______ day of _______________________, 20 _____. 

DATE MONTH YY 

SEAL 






www.imrf.org

Section 6 - IMRF

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