Get Ucrs169

The Ucrs169 form is essential for obtaining an estimate of your buyback from your Benefits Representative and requesting a formal calculation of the cost and resulting benefit of buying back University of California Retirement Plan (UCRP) service credit. This guide provides you with clear, step-by-step instructions to help you successfully complete the form online.

Follow the steps to fill out the Ucrs169 form with ease.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the personal information section. Enter your name, social security number, campus or lab location, mailing address, employee ID number, hire date, daytime phone number, and the effective date of your current UCRP membership if known. Also, check any relevant boxes indicating if you are currently on leave or if any other conditions apply.
3. In the second section regarding approved leave, fill in the dates of leave and your appointment rate during the leave. Indicate whether your leave was unpaid or partially paid, and provide any necessary salary rate details during your leave period. Ensure that you attach the required records based on your employment location.
4. For reestablishing prior UCRP membership, list the dates of your prior membership along with the name(s) you were previously employed under, the campus or lab location, employee ID number for that period, the date of the refund, the amount of refund, and the percentage of time worked during that period.
5. In the noncontributory service section, provide the hire date and the date UCRP contributions began during the specific period of service. If applicable, continue to the certification section.
6. Read the certification for leaves carefully and confirm your understanding by checking the box that applies to your situation. Sign the form and date it, acknowledging the accuracy of the information provided.
7. The benefits office representative should also sign and date the form if required. Ensure that all sections are complete and accurate before submission.
8. Finally, save your changes, and then choose to download, print, or share the completed form as needed.

Complete your Ucrs169 form online today to facilitate your buyback estimates!