S: Use this form to confirm exclusion from membership in PERA of an employee who is a full-time student and under the age of 23. Any refund payable based on this status will be delayed until receipt of this completed form. Part A is to be completed by the student/employee. Part B should be completed by the accredited school in which the student is enrolled full-time, and Part C is to be completed by the employer. Signatures are required in both Parts B and C for this form to be valid. IMPORTANT.
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How to fill out the MN PW00019-01 online
The MN PW00019-01 form is essential for confirming the exclusion from membership in the Public Employees Retirement Association (PERA) for full-time students under 23. This comprehensive guide will help you navigate the form filling process smoothly.
Follow the steps to complete the MN PW00019-01 online.
- Click ‘Get Form’ button to access the MN PW00019-01 form and open it for editing.
- In Part A, the student/employee should clearly print their name, including last, first, and middle initial. Provide the last four digits of the Social Security Number, PERA member number, state, zip code, and full mailing address including number and street, city, and PO Box if applicable.
- Move to Part B, which must be completed by the accredited school. The school official needs to certify that the student is or was in full-time attendance according to their standards. They should provide the name of the school, their signature and title, the beginning date, and the ending date of the full-time attendance.
- In Part C, the employer must confirm the exclusion status based on the school's certification. They should include the name of the employer and department if applicable, the PERA Employer ID, and provide an authorized signature and title, followed by the date.
- Review the entire form for accuracy. Once all parts are completed and signed, the form can be submitted. Users may also save changes, download, print, or share their completed document if necessary.
Complete your MN PW00019-01 form online today to ensure your status is correctly documented.
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