*+22S* TEACHER RETIREMENT SYSTEM OF TEXAS 1000 Red River Street, Austin, Texas 78701-2698 Telephone: (512) 542-6400 or 1-800-223-8778 www.trs.state.tx.us TRS 22S Rev. 08-11 VERIFICATION OF SUBSTITUTE SERVICE AND SALARY Name of Member (please print) Social Security No. Current Mailing Address of the Member TRS MEMBER: This form is to be completed and signed by a current school official of the Texas public educational institution where the service being verified was rendered. After the form has been completed and signed by a school official, you must sign where indicated on the reverse side of this form, before sending the form to the Teacher Retirement System (TRS). See additional instructions on reverse. SCHOOL OFFICIAL: Verify only employment rendered as a substitute on this form. Verify all substitute service rendered in each school year, whether it is more or less than 90 days. Return this form to the member after completion. Do not return this form to TRS. See additional instructions on reverse. Number of Days of Substitute Substituted in what position Gross salary paid for School year Service in the school year (i.e., teacher, bus driver, clerk) this school year Certification of School Official: I certify that records created at or near the time of service in my office show that the person named on this form performed the service listed on this form and show that all information provided on this form is true and correct. I further certify that I am currently employed in the reporting entity below and that this reporting entity is a TRS covered educational institution. The reporting entity agrees to produce records used to verify the service and salary reported on this form to TRS upon request as required under Sections 825.403 and 825.505, Texas Government Code. Signature of School Official Title of School Official Printed Name of School Official Name of Texas Public Educational Institution Date Signed ( ) Telephone Number Notarization of School Official Signature: STATE OF COUNTY OF Before me, a notary public, on (date) personally appeared (school official) known to me to be the person whose name is subscribed to the foregoing document and, being by me first duly sworn, declared that the statements therein are true and correct. GIVEN under my hand and official seal this the day of , Month Year (SEAL) Signature of Notary Public Reverse of Form TRS 22S Rev. 08-11 INSTRUCTIONS FOR MEMBER: To be eligible for TRS membership credit, substitute service must have been for a minimum of 90 days in one school year. Substitute service rendered in more than one school district within the same school year may be combined to meet the 90-day minimum requirement. Take this form to the Texas public school(s) where you rendered service for completion and certification by a school official. After the school official has completed all information, sign below and return this form to TRS. TRS will determine, based on the information provided by the school official and applicable laws and rules, whether your substitute service is eligible for TRS credit. Receipt of this form by TRS does not constitute a guarantee that service credit will be granted by the retirement system. All substitute service rendered prior to September 1, 2011 must be verified no later than September 1, 2016. Beginning with the 2011-12 school year, substitute service must be verified no later than five years after the end of the school year in which it occured. Service that is not verified within the required timeframe will not be eligible for purchase and cannot be used in determining eligibility for or the calculation of any benefits. Verification of substitute service cannot be accepted after you have retired and TRS has issued your first retirement check or after the effective date of your election to participate in the Deferred Retirement Option Plan (DROP). If TRS determines that the substitute service is eligible for TRS credit, TRS will send you a bill for the amount due. All deposits and fees due must be paid in full before this service can be used in the calculation of benefits or to determine your eligibility for benefits. The cost increases each year the amount due remains unpaid. The cost to purchase credit for substitute service rendered prior to September 1, 2011 will increase to the actuarial present value at the time of purchase, if payment in full or a properly completed installment agreement is not received by August 31, 2013. This represents a substantial increase in cost. All substitute service rendered on or after September 1, 2011 will require payment of the actuarial present value at the time of purchase. Purchase of this service credit is optional. I have read the "Instructions for Member" and understand that, if TRS determines that if the substitute service is eligible for credit, I will be required to pay any deposits and fees that are due if I want to have this service included in the calculation of my benefits. I also understand that it is the decision of TRS whether my service is eligible for TRS credit. Signature of Member Date Member Date of Birth INSTRUCTIONS FOR SCHOOL OFFICIAL: All information on the front side of this form must be completed, including the "Certification of School Official." This form must be completed and signed by the current TRS reporting official of the Texas public school district or open enrollment charter school where the service was rendered or by the school district's or charter's payroll manager, payroll supervisor, financial officer, or superintendent. TRS may not accept the form if it is not signed by an appropriate official. This form is to be used only to verify substitute service rendered in a Texas public school. By completing this form and signing the "Certification of School Official," you agree to produce the records used to verify the service and salary listed upon request of the retirement system. Verification must be based on records created at or near the time of service. An affidavit based on memory is not sufficient. RETURN THIS COMPLETED FORM TO THE MEMBER. DO NOT RETURN THIS FORM TO TRS.
© Copyright 2018 AnyForm