Section 6 - IMRF

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• “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. Illinois Municipal Retirement Fund 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 2 of 2
MEMBER INFORMATION CHANGE IMRF Form 6.20 (Rev. 08/2013) 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. STREET (MAILING) ADDRESS CITY, STATE AND ZIP 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: Illinois Municipal Retirement Fund 2211 York Road, Suite 500, Oak Brook, Illinois 60523-2337 Member Services Representatives 800/ASK-IMRF (1-800-275-4673) IMRF Form 6.20 (Rev. 08/2013) can be submitted online via the secure Employer Access area of IMRF’s website, www.imrf.org. Refer to Section 2, Paragraph 2.90 ___________________________________ DATE (MM/DD/YYYY) OR fax this form to: Illinois Municipal Retirement Fund Records Department FAX #(630) 706-4289
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Section 6 - IMRF

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