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Employer Forms

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Forms Index by Subject


Authorized Agent Administration

Checklists for Authorized Agents
Notice of Appointment of Authorized Agent (AA), Form 2.20

Notice of Election or Appointment of Township Supervisor, Form 2.30 Form Obsolete, use Form 2.20

Request for Blank Forms, Form 2.50

Employer Access User ID, Form 2.80 Form Obsolete, Click here to register for an account

To enroll, change accounts or add an account for Electronic Funds Transfer (EFT) for payments made to IMRF Form 3.00
Change the account IMRF will use to send electronic payment for health premiums deducted from employer's retired members’ benefit payments, Form 3.01

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Enrolling an employee in IMRF

All eligible employees

Notice of Enrollment in IMRF, Form 6.10
Submit via Employer Access.

In addition:  
If employee is receiving an IMRF pension Do not enroll this employee before calling IMRF at 1-800-275-4673
City Hospital Employees Election to Participate for Qualifying Position, Form 6.21
All Elected Officials Election to Participate for Qualifying Position, Form 6.21
Resolution for Elected Officials, Form 6.64, if not previously filed
Chief of Police Election of Police Chief to participate as SLEP Member, Form 6.22
Airport Police participating in SLEP Resolution to adopt the IMRF SLEP Program for Airport Police, Form 1.55
If the employee will not participate in Social Security Statement Concerning Employment in a Job Not Covered by Social Security, Social Security Administration Form 1945

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Considering increasing the earnings of a member by 12% or morenew

Employer is considering increasing the earnings of a member by 12% or more (P.A. 97-0609) Request for Pension Impact Statement, Form 3.22

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Changing information for a member

Changes to member's employment or plan

Member Employment Information, Form 6.19
Submit via Employer Access

ECO Member changes plans to SLEP or to Regular IMRF Revocation of Election to Participate in ECO Plan, Form 6.28
Changes to Address, Social Security number, name, birth date, gender

Member Information Change, Form 6.20
Submit via Employer Access

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Terminating an employee

For all terminated members (retires, dismissed, resigns, dies, or no longer eligible for IMRF participation)

Notice of Termination of IMRF Participation, Form 6.41
Submit via Employer Access

Elected official position no longer qualifies for IMRF
Governing body previously determined elected position required performance of duty that met or exceeded employer’s hourly standard, but the duties and responsibilities of the position changed and it no longer meets or exceeds the employer’s hourly standard.

Resolution Relating to Termination of Participation By Elected Officials in IMRF, Form 664T


Member retirement - in addition to Form 6.41 file the following forms
Member retires Application for Retirement Annuity (Pension), Form 5.20
Member can apply for a pension online via Member Access
Copies of birth certificate and marriage/civil union certificate if not previously filed
Member retires under ERI Application for Retirement Annuity (Pension), Form 5.20
Member can apply for a pension online via Member Access
Notice of Intent to Retire under IMRF ERI, Form 5.21 (filed with members retirement application)
Resolution to Adopt IMRF Early Retirement Incentive, Form 6.77, if not previously filed
Copies of birth certificate and marriage/civil union certificate if not previously filed
Member wants to have his or her pension payments “revert” (become payable) to someone else upon the member's death.

Special Needs Annuity Application, Form 5.20R
(filed with the member's retirement application, formerly "Reversionary Annuity Application")

Read more about Special Needs Annuities.

Member or member's surviving spouse wants health insurance premiums deducted from pension payments Health Insurance Premium Deduction Authorization, Form 7.10
Member is a public safety employee when and wants to take a tax deduction of up to $3,000 on their federal income tax return for
health insurance or long term care insurance premiums.

Election For Deductions for Health or Long Term Care Insurance Premiums Paid Directly to Insurer, Form 7.12D

Election For Deductions Health or Long Term Care Premiums Paid through Employer or Endorsed Plan Administrator, Form 7.12E

Member resigns, is dismissed, or job reclassified and no longer qualifies for IMRF
Member stops participating in IMRF and is leaving member contributions on deposit and not forfeiting (not giving up) IMRF service credit Notice of Termination of IMRF Participation, Form 6.41
Submit via Employer Access
Member stops participating in IMRF and is taking a refund of IMRF contributions*

Notice of Termination of IMRF Participation, Form 6.41
Submit via Employer Access

Application for Separation Refund, Form 5.10

*Note - To be eligible for a refund, the member must terminate employment as well as IMRF participation. The member is not eligible for a refund if he or she will continue working for the same unit of government in a position that is not eligible for IMRF or in a position that will participate in a reciprocal or local police or fire fund.

Death of a member
Member was actively participating

Notice of Termination of IMRF Participation, Form 6.41
Submit via Employer Access

Application for Death Benefit, Form 5.30
Death certificate, marriage/civil union certificate (if beneficiary is surviving spouse), beneficiary's birth certificate, divorce decree, if applicable.
Member was receiving IMRF pension

 

Application for Death Benefit, Form 5.30
Copies of death certificate, marriage certificate (if beneficiary is surviving spouse)

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Disability

Member becomes disabled

Member's Application for Disability Benefits, Form 5.40
Member can submit online via Member Access

Employer Statement--Disability Claim, Form 5.41
Submit via Employer Access

Physician's Statement - Disability Claim , Form 5.42

If member also wants health insurance premiums deducted from total and permanent disability benefit payments

Health Insurance Premium Deduction Authorization, Form 7.10
If member is a public safety employee and wants health or long term care insurance premiums deducted from total and permanent disability benefit payments Election For Pre-Tax Deductions For Health or
Long Term Care Insurance Premiums
, Form 7.12
Member returns to work for trial work period after disability Employer's Notice of Termination of Disability or Trial Work Period, Form 5.45

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Leave of Absence

Member is taking unpaid leave of absence and wants to continue to earn IMRF service and maintain IMRF disability and death benefit protection

IMRF Benefit Protection Leave, Form 6.32

Seasonal Leave: Granted automatically for school districts and park districts

Other employer types indicate seasonal months on member's Notice of Enrollment
Indicate seasonal months via Employer Access

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Wage Reporting - Current Year

In the month paid

Submit via Employer Access
If an employer does not have Internet access, use Monthly Deposit Summary, Form 3.10, Form not available online

Submit via Employer Access
If an employer does not have Internet access, use Monthly Report of IMRF Wages & Contributions, Form 3.11, Form not available online
To correct previously reported earnings Employer's Report of Adjustments to IMRF Earnings, Form 3.20
Submit wage adjustments via Employer Access
For members paid irregularly Employers indicate months member will be paid on member's Notice of Enrollment, Form 6.10
Submit member's enrollment via Employer Access
Reporting Seasonal Leave Granted automatically for school districts and park districts, other employers indicate seasonal months on Notice of Enrollment, Form 6.10
Submit member's enrollment via Employer Access
Paying ERI costs
Establish Electronic Funds Transfer IMRF Electronic Funds Transfer (EFT) Enrollment Form, Form 3.00

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Wage Reporting - Prior Years (Includes Purchase of Past Service)

Member's wages and/or contributions were reported in error

Employer's Report of Adjustments to IMRF Earnings, Form 3.20
Submit via Employer Access

Member was reported as Regular IMRF, should have been reported as SLEP Certificate of Sheriff's Law Enforcement Service, Form 6.71

Employer's Report of Adjustments to IMRF Earnings, Form 3.20
Submit via Employer Access

Member wants to convert military service to IMRF service credit Application to Purchase Military Service Credit,Form 6.02J
Member wants to repay a separation refund
A member may repay a refund and reinstate forfeited service credit after he or she participates in IMRF or in a reciprocal system for two years. Application for Reinstatement of Service Credit , Form 6.03
Member wants to purchase retroactive service

Elected official held office qualifying for IMRF before he or she elected to participate (maximum 50 months)

Application for Retroactive Service Credit , Form 6.04

Elected official held office qualifying for IMRF before he or she elected to participate and wishes to purchase more than 50 months.

Please note: In order to purchase more than 50 months of Retroactive Service Credit, the employer or governing body must have passed a resolution allowing this before December 31, 2001. If this resolution is not already on file with IMRF, the member may not purchase more than 50 months of service credit.

Application for Retroactive Service Credit, Form 6.04

 

City hospital employee worked in a position qualifying for IMRF before he or she elected to participate (maximum 50 months)

Application for Retroactive Service Credit , Form 6.04

Member worked in a position qualifying for IMRF but was barred from participation because of age

Application for Retroactive Service Credit for employees previously barred by age, Form 6.04

Member wants to purchase omitted service
Member worked in a position qualifying for IMRF but earning and contributions were never reported to IMRF Omitted Service Credit Verification, Form 6.05
Member wants to purchase prior service
Member worked in a position qualifying for IMRF before his or her employer joined IMRF Application for Prior Service Credit, Form 6.07
Member wants to purchase out-of-state service
Member worked for a local unit of government in another state and participated in its public retirement program. Member must have participated with current IMRF employer for two years Out-of-state Service Credit Authorization, Form 6.33
General Assembly member wants to purchase service earned as an elected official
General Assembly member held office qualifying for IMRF and did not elect to participate in IMRF. Must be a current General Assembly member Application by Member of General Assembly for Service Credit as Elected Official, Form 6.34
Resolution for Elected Officials, Form 6.64, if not previously filed
ECO member wants to convert existing Regular and/or SLEP service to ECO service
Member previously participated in Regular IMRF or SLEP, now participates in ECO Conversion of Regular or SLEP Service Credit to ECO Service Credit, Form 6.06
Member payment for past service
Member wants to pay for past service (military, retroactive, omitted, prior, etc.) with a distribution (money) from an IRA or qualified pension plan Rollover Certification for Payment of Past Service Credit, Form 6.01

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Resolutions -- Military Service Credit or Military Leave

Resolution for Military Leave Authorization, Form 6.62
Resolution to Allow LIMITED Service Credit for Military Leave that INTERRUPTED IMRF Participation, Form 6.62a

Resolution for Military Service Credit, Form 63A

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Miscellaneous Resolutions and Certificates, and Suggested Forms for Resolutions

To adopt the IMRF SLEP Program for Airport Police, Form 1.55
To Allow UNLIMITED Service Credit for Military Leave that INTERRUPTED IMRF Participation, Form 6.62

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

Resolution -- Participation By Elected Officials In IMRF, Form 6.64
Resolution Relating to Termination of Participation By Elected Officials in IMRF, Form 664T

Resolution -- Adoption of the 1,000 Hour Standard for IMRF Participation, Form 6.68

Certificate of Sheriff's Law Enforcement Service, Form 6.71

Resolution to resolution to include compensation paid under an Internal Revenue Code Section 125 Plan as IMRF earnings, Form 6.72
Resolution To Include Compensation Directed Into A Retirement Health Savings Plan As IMRF Earnings, Form 6.73
Resolution to Adopt Early Retirement Incentive, Form 6.77
Resolution to Adopt Amortization Period For IMRF Early Retirement Incentive, Form 6.78
Resolution to Authorize Pension Service Credit for Employees Previously Barred by Age, Form 6.79
Suggested Form of Resolution to Revoke Alternative Benefit Program for County Officers , Form 6.82
Suggested Form of Resolution to Require Additional Member Contributions for Past Service Converted to the Alternative Benefit Program for County Officers, Form 6.83
Resolution for Employer Pick-up (Payment) of Member Contributions Required for Purchase of Service Under ERI, Form 6.85

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Dissolution of School District(s) or Unit(s) of Government

Types of Dissolutions: 
Annexation One employer completely dissolves and is annexed by two or more employers that may be new or already existing IMRF employers
Consolidation Two or more employers completely dissolve and merge to form a completely new employer.
Partial dissolution

One unit of an IMRF employer becomes its own employer or joins with another IMRF employer.

Split dissolution One employer completely dissolves and is annexed by two or more employers that may be new or already existing IMRF employers
Required Documents: 
School District(s) completely dissolved and annexed into existing school district(s) Certificate of Dissolution--Annexing School District (Form 1.70)
Copy of the legal document that caused the annexation, e.g., legislation, referendum, or letter from legal authority authorizing the dissolution.
Unit(s) of government completely dissolved and annexed into existing unit(s) of government Certificate of Dissolution--Annexing Unit of Government (Form 1.72)
Copy of the legislation, referendum or letter from legal authority authorizing dissolution.

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IMRF Online provides a brief summary of IMRF benefits and the adminstration of those benefits. IMRF members' and employers' rights and obligations are governed by Article 7 of the Illinois Pension Code. Statements in these publications are general, and the Illinois state law governing IMRF is complex and specific. If a conflict arises between information in these publications and the law, all decisions are based on the law.

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Page Last Updated by JC on 08.19.13
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