Verification of Substitute Service and Salary_TRS Form 22S

1000 Red River Street, Austin, Texas 78701-2698
Telephone: (512) 542-6400 or 1-800-223-8778
Rev. 08-11
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:
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
Signature of Notary Public
Reverse of Form
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
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
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.