University of Connecticut

Retirement Forms and Checklist


Retirement Forms

Form #

Form Name

Who Must Complete

CO-744

Choice of Health Services After Retirement Form

All retirees

CO-898
CO-898a

Application for Retirement Benefits
Application for Alternate Retirement Program Retirement Benefits

Note:  This form will be completed by Human Resources. 
The employee only signs the form.

SERS/Hybrid Participants
ARP Participants

CO-899

Income Payment Election – Option “A”

SERS/Hybrid participants who elect benefit payment Option A - 50% Spouse

CO-900

Income Payment Election – Option “B”

SERS/Hybrid participants who elect benefit payment Option B - 50% or 100% Survivor

CO-901

Income Payment Election – Option “C”

SERS/Hybrid participants who elect benefit payment Option C - 10 to 20 Years Period Certain

CO-902

Income Payment Election – Option “D”

SERS/Hybrid participants who elect benefit payment Option D - Straight Life Annuity

CO-1047

Spouse Waiver of Monthly Survivor Benefits

SERS/Hybrid participantswho do not elect Option A or Option B (naming spouse as contingent annuitant)

CO-1068

Retirement – Direct Deposit Authorization and Input Form

All retirees

CO-1093

Federal and CT Withholding Tax Change Form

SERS/Hybrid participants

 

Retirement Checklist

Proof of Eligibility (copies, and if in another language, must be translated with notarized affidavit of translation)

 

  Employee Birth Certificate   
  Spouse/Contingent Annuitant Birth Certificate
  Marriage Certificate, Civil Union Certificate
  Birth Certificate for each child to be enrolled in benefits
  Medicare Card with Part B indicated for medicare-eligible persons to be enrolled in benefits
     

SERS or Hybrid Pension Benefits

 
  Application for Retirement (C0-898)
  Income Payment Election (CO-899, 900, 901 or 902)
  Spouse Waiver of Monthly Survivor Benefits (CO-1047)
  Federal and CT Tax Withholding Change Form (CO-1093)
  Direct Deposit Authorization and Input Form (CO-1068)
     

ARP Pension Benefit

  Application for Retirement (CO-898a)
     

Retiree Health Benefits

 
  Choice of Health Services after Retirement Form (CO-744)
     

Retiree Life Insurance

 
  If you want to convert the reduction in your life insurance benefit to a personal life insurance policy: Contact Fort Dearborn
     

Supplemental Benefits

 
  If you want to continue benefits on a direct bill basis with your current carriers, contact the carriers directly:
 
  Life Insurance (Fort Dearborn, Aetna, or ING)
  Auto and Homeowner Insurance (Liberty Mutual, MetLife, or Travelers)
  Long Term Care (Transamerica or MedAmerica)