Membership Tier Verification Form

Membership Tier Verification Form

This form is designed to help SBCERA employers place new members in the correct retirement plan immediately upon hire.

Employer Requirement: You must provide this form to all newly hired SBCERA members and only return to SBCERA if the person appears to qualify for Tier 1 membership. Both you and the new hiremust complete this form. SBCERA must process this form before the end of the employee’s first pay period.

Form Submission: This form must be submitted to SBCERA through EmployerDirect, our secure online portal for participating employers.

SBCERA Waiver of Membership (60+) Form

SBCERA Waiver of Membership (60+) Form

This form serves as a waiver of membership for members who have attained the age of sixty or greater prior to employment.

Employer Requirement: You must provide this form to all new hires who are 60 and above. The form should be returned to SBCERA even if the employee is not waiving membership. SBCERA must process this form before the end of the employee’s first pay period.

Form Submission: This form must be submitted to SBCERA through EmployerDirect, our secure online portal for participating employers.

Pay Code Request Form

Pay Code Request Form

This form is designed to assist employers when establishing new pay codes to determine whether pay items are compensation earnable and/or pensionable compensation and SBCERA contributions are required.

Employer Requirement: This form must be submitted prior to the pay item being paid to employees and reported to SBCERA. Please answer all questions and provide any supporting documentation such as MOU, board approval, and/or side letter agreement. SBCERA will review and advise whether the pay code is reportable as compensation earnable for Tier 1 or pensionable compensation for Tier 2. Staff advisory opinions are subject to approval by the Board of Retirement. 

Form Submission: Send this form by email to Employers@SBCERA.org.

Post-Retirement Employment Forms

Returning Retiree Certification Form

This form is required if a retiree returns to work for an SBCERA-covered employer either part-time or in a limited-term capacity while continuing to receive their monthly retirement benefit. Once you have completed the sections that apply, provide the form to the retiree for review and signature.

Employer Requirement: You must submit this form to SBCERA and receive SBCERA’s authorization for the retiree to return to work before the retired member begins working.

Form Submission: County departments should submit directly to County Human Resources at ebsd@hr.sbcounty.gov. All other Employers should submit the form to SBCERA at ReturningRetirees@SBCERA.org or by mail at SBCERA, Attn: Member Services, 348 W. Hospitality Lane, Suite 100, San Bernardino, CA 92408.

Returning Retiree Certification Extension Request Form

This form is required for a returning retiree to work beyond the initial 18-month period authorized by the Returning Retiree Certification Request form.

Employer Requirement: You must submit this form to SBCERA six to eight weeks before the retiree’s return-to-work certification expiration date because it requires approval by the SBCERA Board of Retirement.

Form Submission: County departments should submit directly to County Human Resources at ebsd@hr.sbcounty.gov. All other Employers should submit the form to SBCERA at ReturningRetirees@SBCERA.org or by mail at SBCERA, Attn: Member Services, 348 W. Hospitality Lane, Suite 100, San Bernardino, CA 92408.

Disability Retirement Questionnaire

This form is required when an SBCERA retiree who was granted a Disability Retirement benefit is being considered for re-employment as a retired annuitant with an SBCERA-covered employer.

Employer Requirement: Employers must complete this form and submit it with the Returning Retiree Certification Form form.

Form Submission: Submit this form and any supporting documents to SBCERA at ReturningRetirees@SBCERA.org or by mail at SBCERA, Attn: Member Services, 348 W. Hospitality Lane, Suite 100, San Bernardino, CA 92408.

Employment Relationship Questionnaire - Employer

Employment Relationship Questionnaire - Retiree

These forms are required if an SBCERA-covered employer is hiring a retired SBCERA member as an Independent Contractor or Sub-Contractor. SBCERA will review the information on the forms to determine whether an employer-employee relationship exists between the participating employer and retiree.

Employer Requirement: You must complete the Employment Relationship Questionnaire for Employers and submit to SBCERA. In addition, provide the Employment Relationship Questionnaire for Retirees to the retiree who is being hired as an Independent Contractor or Sub-Contractor and submit the retiree’s completed form to SBCERA.

Form Submission: Submit this form and any supporting documents to SBCERA at ReturningRetirees@SBCERA.org or by mail at SBCERA, Attn: Member Services, 348 W. Hospitality Lane, Suite 100, San Bernardino, CA 92408.