CERTIFICATION OF EMPLOYMENT UNDER SECTION 212
FOR MEMBERS OF THE OPTIONAL RETIREMENT PROGRAM
To:
The City University of New York
University Benefits Office
535 East 80th Street, Room 602
New York, NY 10021
,a TIAA-CREF service retiree under the age of 65, certify that
I,
I have accepted a position in public service with New York State or its political subdivisions and wish to
continue to
to receive
treceivemy retirement allowance.
I understand that, if my earnings from public service exceed the earnings permitted under Section 212 of
the Retirement and Social Security Law for the calendar year
, my retirement allowance may be
reduced or suspended in accordance with applicable provisions of law.
Signature:
Date
-All information must be provided below-
S.S. #
Name:
First Name
MI
-
-
Last Name
Address:
Date of Birth:
Date of Retirement
CUNY Campus Retired From
Title of Position Retired From
Current Employer:
NOTE: This election is valid only during the calendar year indicated above. A new election must be
completed for each calendar year during which you work in public service for New York State or any of its
political subdivisions. Retired members of theO R P need to apply for a waiver under 211 of the RSSL if
their earnings in public service will exceed the 212 earnings limit, which changesevery
every calendar year.
Please consult your Personnel Office for details.