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Contractor or Third-Party Worker Contact Information for <br /> g <br /> D <br /> Retirement Status Verification DRS Employer Support Services <br /> 360.664.7200,option 2 <br /> WASHINGTON STATE This form is for employers to use to verifythe retirement status $00.547.6657,option 6, option 2 <br /> Department of employersupport@drs.wa.gov <br /> Retirement Systems of a worker paid through accounts payable or a third party. <br /> Employer Information <br /> Failure to report a retiree to DRS can result in a significant liability to the employer for pension overpayments. <br /> Some workers are considered to be employees of both your agency and the third party (dual employers). <br /> A retiree who is in an employee/employer relationship with your agency is subject to the same <br /> retiree-return-to-work(RRTW) rules as an employee paid through payroll. <br /> Additionally, workers age 65 or younger who retired using the 2008 Early Retirement Factors (ERF) are subject <br /> to stricter return-to-work rules and cannot perform services in any capacity for a DRS-covered employer and <br /> continue to receive a benefit. <br /> Employer Instructions <br /> • Use Member Reporting Verification (MRV) to review the worker's retirement status. <br /> • Did the-worker retire from a DRS-covered plan? ❑ Yes ❑ No <br /> If yes and in an employee/employer relationship with your agency, report using RRTW rules. <br /> • Did the worker retire using the 2008 ERF? ❑ Yes ❑ No <br /> If yes, contact Employer Support Services (ESS) immediately. <br /> • Sign and date this form. <br /> • Retain this form for three years beyond your relationship with the worker. <br /> Worker Information <br /> Worker Name(Last,First,Middle) 1 Social Security Number <br /> (.7(-N5C>..� L - 06,0 - 3V- o // <br /> If your agency doesn't directly pay the worker,name the company or contractor paying the worker. <br /> Identify the Type of Worker(Check Only One) <br /> ❑ Employee Hired Through a Third Party(Staffing Agency,Temp Agency, Etc.) <br /> Et/Independent Contractor <br /> ❑ Worker Provided by Company or Contractor Your Agency Hired to Perform Services <br /> Employer Signature <br /> I have verified the information above using MRV or by contacting a DRS representative.I acknowledge that failure to properly report <br /> a 2008 ERF retiree to DRS can result in a liabi'ty to the employer. <br /> Employer Signature Date <br /> DRS MS 346(R 2/16) 1 1111III 1111111111111111IIUI III3 1111111111 III 1111 <br /> D R S M S 4 6 <br />