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The TRSNYC RW116 form is an essential document for individuals looking to withdraw their Additional Member Contributions (AMCs) upon retirement. This application is specifically designed for those who have participated in the Age 55 Retirement Program and are now ready to manage their contributions. To successfully complete this form, applicants must provide personal information, including their Social Security number and TRS membership number. The form outlines several eligibility criteria, such as retiring at age 62 or older while maintaining active service before the retirement date, or retiring due to Ordinary or Accident Disability. When filling out the application, individuals must also choose how they wish to receive their withdrawal, whether through a direct payment or a rollover into an eligible IRA. It's important to note that if opting for a rollover, a separate form must be attached. Additionally, tax implications are highlighted, as the IRS mandates a 20% withholding on taxable amounts unless otherwise rolled over. For those seeking assistance, the TRS website offers further resources, and a dedicated Member Services Center is available for inquiries. Completing this form accurately and understanding its requirements can significantly impact retirement planning and financial management.

Preview - Trsnyc Rw116 Form

APPLICATION FOR WITHDRAWAL OF

ADDITIONAL MEMBER CONTRIBUTIONS

AT RETIREMENT

INSTRUCTIONS

PLEASE READ CAREFULLY

•฀฀฀Please฀ile฀this฀application฀if฀you฀elect฀to฀withdraw฀(and/or฀directly฀roll฀over)฀the฀employee฀portion฀of฀your฀ Additional฀Member฀Contributions฀(AMCs).

•฀฀฀You฀may฀use฀this฀application฀if฀you฀were฀previously฀enrolled฀in฀the฀Age฀55฀Retirement฀Program฀and฀one฀of฀ the฀following฀applies:฀฀฀

➢You฀retired฀at฀age฀62฀or฀above฀and฀met฀the฀following฀requirements:฀

•฀฀฀You฀were฀in฀active฀service฀immediately฀prior฀to฀your฀effective฀retirement฀date;฀

•฀฀฀You฀were฀in฀active฀service฀for฀a฀total฀of฀at฀least฀six฀months฀out฀of฀each฀of฀the฀two฀ twelve-month฀periods฀preceding฀your฀retirement.

➢฀You฀retired฀under฀Ordinary฀Disability฀or฀Accident฀Disability฀retirement.

•฀฀฀If฀you฀elect฀to฀directly฀roll฀over฀all฀or฀part฀of฀the฀taxable฀portion฀of฀your฀withdrawal฀to฀one฀or฀more฀eligible฀ Individual฀Retirement฀Arrangements฀(IRAs)฀or฀other฀successor฀programs,฀you฀must฀attach฀a฀completed฀ “QPP฀Direct฀Rollover฀Election฀Form”฀(code฀RW29)฀with฀this฀application.฀In฀all฀cases,฀the฀tax-free฀portion฀of฀ your฀withdrawal฀will฀be฀paid฀directly฀to฀you.

•฀฀฀For฀your฀convenience,฀TRS฀forms฀and฀publications฀are฀available฀on฀our฀website.฀If฀you฀require฀additional฀ assistance,฀we฀encourage฀you฀to฀contact฀our฀Member฀Services฀Center฀at฀1฀(888)฀8-NYC-TRS.

In฀Part฀A:฀฀All฀information฀must฀be฀provided.

In฀Part฀B:฀฀You฀must฀elect฀how฀your฀withdrawal฀will฀be฀distributed.

You฀may฀elect฀to฀receive฀your฀withdrawal฀through฀one฀of฀the฀following฀methods฀or฀a฀combination:

•฀฀Direct฀Withdrawal,฀in฀which฀the฀withdrawal฀would฀be฀made฀payable฀directly฀to฀you.

•฀฀฀Direct฀Rollover,฀in฀which฀all฀or฀part฀of฀the฀taxable฀portion฀of฀your฀withdrawal฀would฀be฀made฀payable฀directly฀to฀an฀eligible฀IRA(s)฀or฀ other฀successor฀program(s).

If฀you฀are฀receiving฀payments฀from฀TRS฀via฀Electronic฀Fund฀Transfer฀(EFT)฀to฀your฀checking฀or฀savings฀account,฀you฀may฀be฀eligible฀ to฀have฀your฀Direct฀Withdrawal฀also฀forwarded฀to฀this฀account.฀If฀you฀are฀not฀eligible฀to฀receive฀your฀withdrawal฀via฀EFT,฀it฀will฀be฀ mailed฀to฀your฀home฀address.

If฀you฀elect฀to฀directly฀roll฀over฀all฀or฀part฀of฀your฀withdrawal฀of฀your฀AMCs,฀you฀must฀ile฀a฀“QPP฀Direct฀Rollover฀Election฀Form”฀in฀ conjunction฀with฀this฀application.

In฀Part฀C:฀฀You฀must฀read฀the฀attestation฀and฀sign฀and฀date฀this฀form.

In฀Part฀D:฀฀You฀must฀have฀this฀application฀notarized.

RW116 (10/11)

CONTINUED ON PAGE 2

PAGE 1

CONTINUED฀FROM฀PAGE฀1

TAX CONSEQUENCES

•฀฀฀The฀taxable฀portion฀of฀any฀withdrawn฀Qualiied฀Pension฀Plan฀(QPP)฀funds฀is฀taxable฀upon฀receipt฀and฀will฀be฀reported฀to฀ the฀Internal฀Revenue฀Service฀(IRS)฀in฀January฀following฀the฀calendar฀year฀in฀which฀it฀is฀distributed.฀The฀IRS฀requires฀that฀ TRS฀withhold฀20%฀of฀any฀taxable฀amount฀you฀withdraw฀that฀you฀do฀not฀instruct฀TRS฀to฀directly฀roll฀over฀into฀an฀eligible฀ IRA(s)฀or฀other฀successor฀program(s).฀This฀20%฀will฀be฀forwarded฀to฀the฀IRS฀and฀credited฀toward฀your฀taxes฀for฀the฀year฀of฀ distribution.฀(Within฀60฀days฀of฀the฀distribution฀date,฀you฀may฀roll฀over฀any฀taxable฀amount฀you฀receive,฀or฀roll฀over฀the฀entire฀ amount฀of฀the฀distribution฀by฀replacing฀the฀20%฀withheld฀by฀TRS฀with฀money฀from฀other฀sources.)

RW116 (10/11)

CONTINUED ON PAGE 3

PAGE 2

APPLICATION FOR WITHDRAWAL OF

ADDITIONAL MEMBER CONTRIBUTIONS

AT RETIREMENT

Please฀read฀the฀instructions฀before฀completing฀this฀application.

(NOTE:฀Please฀print฀in฀black฀or฀blue฀ink,฀and฀initial฀any฀changes฀that฀you฀make฀on฀this฀application.)

PART฀A:฀฀All฀information฀must฀be฀provided.

First฀Name฀

 

MI฀

Last฀Name฀฀

 

฀

 

Social฀Security฀Number฀(last฀4฀digits฀only)

 

 

 

 

 

 

 

 

 

 

 

 

X

 

X

 

X

 

 

 

X

 

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Permanent฀Home฀Address฀

 

฀

 

฀

 

 

฀

 

Apt.฀No.฀ TRS฀Membership฀Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City฀

 

฀

 

State฀฀ Zip฀Code฀

 

฀

 

Primary฀Phone฀Number฀(Check฀one:฀฀฀฀฀฀฀Home฀฀฀฀฀฀฀Work฀฀฀฀฀฀฀Mobile)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(฀

 

 

 

 

฀฀฀฀฀)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

฀฀

 

฀

 

฀

 

 

฀

 

฀

 

Alternate฀Phone฀Number฀(Check฀one:฀฀฀฀฀฀฀Home฀฀฀฀฀฀฀Work฀฀฀฀฀฀฀Mobile)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(฀

 

 

 

 

 

฀฀฀฀฀)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please฀keep฀your฀personal฀information฀with฀TRS฀up฀to฀date.฀฀We฀will฀update฀our฀records฀based฀on฀the฀information฀you฀provide฀ above,฀so฀do not enter a temporary address;฀instead,฀TRS฀suggests฀that฀you฀consult฀the฀U.S.฀Postal฀Service฀about฀having฀your฀mail฀ forwarded฀on฀a฀temporary฀basis.฀฀To฀register฀any฀changes฀to฀your฀permanent฀address฀(and/or฀phone฀number),฀please฀access฀our฀ website฀or฀ile฀a฀“Member’s฀Change฀of฀Address฀Form”฀(code฀DM13)฀with฀TRS.

If฀you฀are฀providing฀new฀information฀above,฀please฀indicate฀the฀effective฀date:฀฀

PART฀B:฀฀Please฀elect฀ONE฀of฀the฀following฀choices฀and฀write฀your฀initials฀in฀the฀space฀provided฀next฀to฀your฀choice.

___฀

฀

฀

฀

___฀

I฀ want 100% of my withdrawal paid directly to me. I understand that TRS is required to withhold 20% of the taxable amount distributed, that this amount will be forwarded to the IRS, and that I may claim the amount as federal tax paid on my tax return for the year of distribution.

Please฀elect฀how฀you฀would฀like฀to฀receive฀your฀payment;฀see฀EFT฀eligibility฀requirements฀on฀page฀1.

฀฀฀฀฀฀฀by฀Mail฀฀฀฀฀฀฀฀฀฀via฀EFT฀(If฀you฀are฀ineligible฀to฀receive฀your฀payment฀via฀EFT,฀a฀check฀will฀be฀mailed฀to฀your฀home฀address.)

฀

฀

฀

฀

OR

I฀

want to roll over ALL OR PART of the taxable portion of my withdrawal, and I have therefore attached a “QPP Direct

Rollover Election Form” (code RW29) to this form.

RW116 (10/11)

CONTINUED ON PAGE 4

PAGE 3

CONTINUED฀FROM฀PAGE฀3

PART฀C:฀฀Please฀complete฀the฀following฀and฀sign฀and฀date฀below฀in฀the฀presence฀of฀a฀notary.

I certify that I have retired from my TRS-eligible position and hereby apply to withdraw the employee portion of my Additional Member Contributions (AMCs). I have read the accompanying instructions, including the eligibility requirements for this withdrawal, and I certify that the information I have provided above is accurate to the best of my knowledge.

MEMBER’S฀SIGNATURE฀________________________________________ DATE฀(M/D/Y)฀____________________________

PART฀D:฀฀TO฀BE฀COMPLETED฀BY฀A฀NOTARY฀(NOTE:฀Attestation฀made฀outside฀the฀U.S.฀must฀be฀executed฀before฀an฀American฀consul.)

State฀of฀฀

)

฀

)฀s.s.:

County฀of฀฀ __________________________ )

฀On฀the฀_______________฀day฀of฀__________________________,฀__________,฀before฀me฀personally฀appeared฀the฀person

฀known฀to฀me฀to฀be฀______________________________________________________________________________,฀

the฀individual฀who฀executed฀the฀foregoing฀instrument฀and฀acknowledged฀to฀me฀that฀(s)he฀executed฀the฀same. Signature:฀______________________________________________________________฀

Oficial฀Title:฀________________________________________฀Expiration฀Date฀of฀Commission:฀________________________

RW116 (10/11)

PAGE 4
Get Trsnyc Rw116 PDF Form

Form Characteristics

Fact Name Details
Purpose This form is used to apply for the withdrawal of Additional Member Contributions (AMCs) at retirement.
Eligibility Eligible if retired at age 62 or older, or under Ordinary or Accident Disability retirement.
Withdrawal Methods Withdrawals can be received as a direct payment or rolled over to an eligible IRA.
Tax Withholding TRS is required to withhold 20% of any taxable amount withdrawn, which will be reported to the IRS.
Required Attachments If rolling over, a completed "QPP Direct Rollover Election Form" (code RW29) must be attached.
Contact Information For assistance, contact the Member Services Center at 1 (888) 8-NYC-TRS.
Notarization Requirement The application must be notarized to be valid.
Governing Law This form is governed by New York State laws applicable to the Teachers' Retirement System (TRS).
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