Get IL CTPF 770 2015-2021

Ctpf.org A CTPF retiree who returns to work for a Chicago Board of Education BOE or a Chicago Charter School employer must not exceed re-employment limits or pension benefits and health insurance subsidies will be cancelled. Retirees who intend to seek re-employment with a BOE/Chicago Charter School employer must file this form with CTPF before returning to work and complete any additional forms required by the Employer. Notice of Return to Work P Chicago Teachers Pension Fund FORM 770 rev* 6/2015 203 North LaSalle Street suite 2600 Chicago Illinois 60601-1231 Phone 312 641 4464 Fax 312 641 7185 www. CTPF s Rules Governing Re-Employment can be found at www. ctpf*org. SECTION 1 MEMBER INFORMATION Member name first Mailing address middle initial last Last 4 digits of SSN street city Birthdate mm/dd/yy apt. or unit no. state zip Telephone number with area code E-mail address Did you work as a principal/administrator for at least five years prior to retirement Did you retire under the Illinois Reciprocal Act o Yes o No If you answered yes please list your final system SECTION 2 EMPLOYMENT INFORMATION Date of return to work School or attendance center Principal/supervisor ACKNOWLEDGEMENT I certify that my return to work is temporary and non-annual and complies with the statutory limits outlined in the CTPF publication Rules Governing Re-Employment. I also understand that if I exceed the statutory limits my pension benefits and health insurance subsidies will be cancelled retroactive to the date the statutory limits were exceeded* I will be obligated to repay all pension benefits and health insurance subsidies received from the date the limit was exceeded* I understand it is my sole responsibility to track the number of days and hours I work as well as the compensation I receive as well as to understand which compensation limit applies to me. CTPF s Rules Governing Re-Employment can be found at www. ctpf*org. SECTION 1 MEMBER INFORMATION Member name first Mailing address middle initial last Last 4 digits of SSN street city Birthdate mm/dd/yy apt. or unit no. state zip Telephone number with area code E-mail address Did you work as a principal/administrator for at least five years prior to retirement Did you retire under the Illinois Reciprocal Act o Yes o No If you answered yes please list your final system SECTION 2 EMPLOYMENT INFORMATION Date of return to work School or attendance center Principal/supervisor ACKNOWLEDGEMENT I certify that my return to work is temporary and non-annual and complies with the statutory limits outlined in the CTPF publication Rules Governing Re-Employment. or unit no. state zip Telephone number with area code E-mail address Did you work as a principal/administrator for at least five years prior to retirement Did you retire under the Illinois Reciprocal Act o Yes o No If you answered yes please list your final system SECTION 2 EMPLOYMENT INFORMATION Date of return to work School or attendance center Principal/supervisor ACKNOWLEDGEMENT I certify that my return to work is temporary and non-annual and complies with the statutory limits outlined in the CTPF publication Rules Governing Re-Employment. I also understand that if I exceed the statutory limits my pension benefits and health insurance subsidies will be cancelled retroactive to the date the statutory limits were exceeded* I will be obligated to repay all pension benefits and health insurance subsidies received from the date the limit was exceeded* I understand it is my sole responsibility to track the number of days and hours I work as well as the compensation I receive as well as to understand which compensation limit applies to me. .