Heading 2 | ERSRI

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Please complete and submit this form to report the death of an ERSRI member or payee.
Note: Fields with an asterisk* are required.

YOUR CONTACT INFORMATION

Your First Name

Your Last Name

Your Email address

Your Phone Number

Your Mailing Address Line 1

Your Mailing Address Line 2

City, State, Zip

Your Relationship to Member

MEMBER’S INFORMATION

Member’s Full Name

Member’s Date of Death

Member’s Date of Birth

Member’s SSN (last 4 digits) – if known:

Please enter any additional information as needed

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Haga clic en los enlaces a continuación para leer los números de Compas en español en línea:

Compas en español - Enero 2025

Compas en español - Noviembre 2024

Compas en español - Septiembre 2024

Compas en español - Julio 2024

Compas en español - Mayo 2024

Actuarial Valuations as of 6/30/2024

Please complete and submit this form and we will be in touch with you soon. Note: Fields with a asterisk are required.

First Name

Last Name

Email address

Phone Number

Date of Birth

Are you retired - either receiving a monthly Service Retirement or Disability benefit from ERSRI, or have a retirement benefit that is awaiting processing?

Yes

No

If yes, please provide your retirement date.

Please provide the following information about the Agency/Employer and position from which you retired.

Former Agency/Employer Name

Former Position

Please provide the following information about the position you are interested in working as a retiree:

Prospective Start Date (or Actual Start Date, if already accepted or begun)

Post-Retirement Agency/Employer

Post-Retirement Position

Brief description of job duties.

Enter your question(s) in the space below. Provide as much detail as possible.

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Employer Guidance for Completing Forms

These employer presentations provide direction on completing the forms ERSRI requires for a member at the time of retirement. Covers the Employer Certification of Retirement and Final Wages, Salary Verification for Service Credit, Verification of Retroactive Salary, and Teacher Day Count forms. Click on the applicable link below to view the presentations:

State of Rhode Island Employer Forms Training

A guide to state employer retirement forms.

Municipalities Forms Training (includes non-teacher school employees)

A guide to retirement forms for municipal employers.

Public Schools (Teachers) Forms Training

A guide to retirement forms for teacher employers.

Employer Certification of Retirement and Final Wages

Use this Employer Certification of Retirement upon retirement of an employee.

Employer Certification of Termination

Use this Employer Certification Termination form upon termination of an employee.

Salary Verification of Service Credit

Use this form to help ERSRI determine service credits based on a member’s salary.

Teacher Day Count Verification

Use this form to help ERSRI determine service credits based on the number of days worked by a teacher.

Verification of Retroactive Salary

Use this form to provide ERSRI detail of retroactive salary paid to an employee.

Post-Retirement Employment Tracking Form

Retirees working under Post-Retirement provisions may use this worksheet to report or track the days worked each month for their ERSRI-participating employer. THIS WORKSHEET SHOULD NOT BE SUBMITTED TO ERSRI. The retiree working Post-Retirement Employment should submit this worksheet directly to their employer, if directed.