ROLLOVER REQUEST FOR SERVICE CREDIT PURCHASES

     OR REPAYMENT OF PREVISOULY WITHDRAWN CONTRIBUTIONS

 

The Public Employees’ Retirement System of Nevada (PERS) is a qualified plan under Section 401(a) of the Internal Revenue Code. PERS may accept eligible rollover distribution from another qualified trust for purchasing service credit.  A qualified trust is a qualified plan under section 401(a), 401(k), 403(b) or 457 of the Internal Revenue Code, or the money contained in an individual retirement account (IRA).  The amount rolled over to PERS cannot exceed the retirement benefit portion of the purchase cost and must be made in a lump sum payment.  This form must accompany the rollover to allow PERS to process it as an eligible rollover distribution.

 

SECTION 1.  To be completed by PERS.

Member's Name (Last, First, Middle):		Social Security Number:
Type of Service Credit:	Amount of Service Credit:	Maximum Rollover Amount: $

SECTION 2.  To be completed by member requesting rollover.

I request that PERS accept my eligible rollover distribution, not to exceed the retirement portion of the purchase cost.  I certify that if this deposit to PERS is from a regular rollover distribution that all required withholding amounts have been withheld from such distribution.
Signature of  Member:  (required)
Date:	Telephone Number:

SECTION 3.  To be completed by Administrator of eligible retirement plan or IRA custodian.

Name of Qualified Plan or Custodian of Conduit IRA:		Pre-Tax Rollover Amount $		Post-Tax Rollover
Mailing Address:	City:		State:		Zip Code:
Type of Account:
Date of Rollover:  (required)
As administrator of the above-named qualified plan or custodian/trustee of a 401(a), 403(b), 457 or Individual Retirement Account (IRA), I certify that this distribution meets the requirements of the IRC section 401.
Signature of Plan Administrator:  (required)	Printed Name and Title			Date:

*This amount is due no later that 60 days of receipt of the signed form by PERS otherwise the request is void.

 

 

 

 

 

 

 

 

 

 

INFORMATION ON REQUESTING A ROLLOVER FROM

OTHER QUALIFIED PLANS FOR SERVICE CREDIT PURCHASES

OR REPAYMENT OF PREVIOUSLY WITHDRAWN CONTRIBUTIONS

 

PERS service credit may be purchased and previously withdrawn contributions may be repaid  through a rollover from another retirement plan qualified under Section 401(a), 401(k), 403(b) or 457 of the Internal Revenue Code.  This also includes Individual Retirement Accounts (IRA).  For a rollover payment to be accepted by PERS, the following conditions must be met:

 

v    Rollovers must comply fully with the Internal Revenue Code and applicable Internal Revenue Service regulations. 

 

v    PERS rollover request form must be completed and accompany the rollover to allow PERS to process it as an eligible rollover distribution.

 

v    The member must contact PERS to obtain the cost of the service credit to be purchased.

 

v    The member must forward this form to the plan administrator currently holding the funds to verify the distribution and that the monies are from a qualified plan.

 

v    If the funds are to be rolled over from an Individual Retirement Account (IRA), section 3 of this form must be completed by the current IRA provider verifying the pre- and post-tax amounts.

 

v    The rollover check from the qualified plan must be made payable to the Public Employees' Retirement System of Nevada, for benefit of (member's name).  The check must be delivered to PERS with this form.

 

v    PERS will only accept payment of the amount listed in Section 1 of this form.  IF the distribution from the originating institution is greater than the cost, the originating institution must be willing to generate separate checks, making one payable to PERS for the exact amount listed in Section 1.

 

v    If the payment to PERS is in excess of the cost, the rollover will be rejected in total.  IF the distribution from the originating institution is less than the total due for the service credit, only a prorated portion (as determined by PERS) will be credited.  A separate agreement will be required for any other service credit to be purchased.

 

v    Rollover contributions used to purchase service credit or repay previously withdrawn contributions cannot be withdrawn unless your PERS covered employment is terminated.

 

Members may wish to contact a tax advisor for detailed information about eligible rollover distributions.