Employment After Ret Disability Elect_TRS Form 118D

TEACHER RETIREMENT SYSTEM OF TEXAS
1000 Red River Street, Austin, Texas 78701-2698
Telephone (512) 542-6400 or 1-800-223-8778
*+118D*
TRS 118D
Rev. 08-11
EMPLOYMENT AFTER RETIREMENT
DISABILITY ELECTION
Social Security
2. Number
1. Retiree's Name
3. Name of
Employing Institution
I realize I can make an election on a one-time trial basis to work on as much as a full time basis
for a Texas public educational institution for a period not to exceed three consecutive months.
During this period TRS will not withhold my monthly benefit payment nor will TRS contributions
be withheld from my salary.
A.
I hereby elect the following months (must be consecutive), as my three-month trial period:
, and
,
B.
I realize working any part of a month counts as a full month.
C.
I have not previously elected a three-month trial period.
D.
I realize I will not be entitled to service credit for the months or compensation credit for
salary paid during the three-month period.
E.
I understand that if I retired after August 31, 2007, I am subject to a limit on the amount of
annual compensation I may earn while receiving disability retirement benefits. The
compensation limit includes compensation I receive during the three month trial period. If I
exceed the annual limit, I am subject to loss of monthly benefits and increased cost for TRSCare retiree health benefit coverage.
F.
If I continue to work full time beyond the three-month trial period, I understand that I will not
be entitled to any further disability annuity payments, or TRS-Care retiree health benefits and
will return to active membership.
I certify that the above information is true and correct, and that I am electing to have this trial period
apply for the designated months. I understand that this form must be filed with TRS before the end
of the trial period for my election to be effective.
I further understand that this is a one-time only trial period.
Signature of Retiree
EMPLOYER CERTIFICATION
Date
This is to certify that the proposed employment as described above will be reported to TRS as
required in State law and TRS rules and procedures.
Signature of Reporting Official
Name of Reporting Entity (Employer)
Title
TRS Employer Number
Date