Follow the steps to fill out your Rasl Arizona application effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by checking the appropriate box at the top of the form to indicate whether this is an original request or a change of information.
3. In the top portion of the form, complete the following fields: - **Social Security number**: Enter your Social Security number. - **Retiree name**: Provide your last name, first name, and middle initial. - **Retiree phone number**: Enter a contact number where you can be reached regarding the RASL program. - **Retiree mailing address**: Provide your current mailing address for communications and disbursements. - **Retirement system**: Select the appropriate state retirement system you have participated in (ASRS, CORP, ORP, or PSPRS). - **Retirement date**: Enter the established retirement date confirmed with your retirement system. - **Retiree birth date**: Fill in your birth date for administrative purposes. - **Retiree gender**: Check the box for male or female for administrative purposes. - **EIN**: Leave blank if you are a university retiree or enter the ADOA HRIS employee identification number. - **Deferred compensation election**: Check this box if choosing deferred compensation for your first installment and ensure to meet enrollment responsibilities. - **Disbursements**: Indicate your preference for payments by checking the appropriate box, noting that a VOID check or letter from your financial institution is required for direct deposit requests. - **Withholdings**: Determine your tax withholding option, either maintaining the most recent or attaching completed tax forms. - **Beneficiary information**: Provide the name, phone number, and address of the person designated as your beneficiary, or state 'No Beneficiary' if applicable. - **Signature**: Sign the form to certify the information is correct, as a missing signature will invalidate the form.
4. In the bottom portion of the form, the agency that employed you will need to complete the following fields: - **AGY**: Record the two-letter agency code. - **Agency name**: Write the full name of the agency. - **Date**: Fill in today’s date (the date the form is filled out). - **Agency contact name**: Provide the name of the individual responsible for the RASL program. - **Agency telephone number**: Enter the phone number of the agency contact. - **Last day employed**: Record your last day of employment, ensuring supporting documentation is attached. - **Paid off other leave**: Date when all other leave was paid off by the agency. - **Sick leave balance (hours) upon separation**: Note the final sick leave hours you have recorded, with attached documentation. - **Hourly rate at separation date**: Enter your final hourly rate at separation, ensuring documentation to verify this amount. - **YTD FICA taxable wages**: Enter your final year-to-date FICA taxable wages, attaching supporting documentation. - **Employer signature**: This must be signed by an authorized individual from the agency.
5. Once the form is completed by both the retiree and the agency, submit it along with all required backup documentation to the Arizona Department of Administration (ADOA) GAO. Ensure that the submission is made within the specified deadline to claim benefits.

Complete your Rasl Arizona application online today to ensure a smooth processing of your benefits.