QPP Direct Rollover Application for Lump-Sum QPP Death Benefit

To submit this form, ensure all sections are fully completed and accurate. Submit the notarized 'Attestation and Notarization for Online Death Benefit Claim' or 'Claimant's Statement' alongside this application. Mail the completed form to Teachers' Retirement System, 55 Water Street, New York, NY 10041. Alternatively, you can submit electronically via the TRS website or fax to the number provided on the TRS Member Services page. Ensure timely submission to preserve distribution options. For additional guidance, contact TRS Member Services at 1 (888) 8-NYC-TRS.

Important dates for this form in 2024 and 2025 include the calendar year deadlines following the year of the member's death. Beneficiaries must submit the form within the specified timeline to ensure eligibility for distribution options.

This form serves as an application for designated beneficiaries to directly roll over a lump-sum death benefit from the Teachers' Retirement System of the City of New York's Qualified Pension Plan (QPP) to an Inherited Individual Retirement Arrangement (IRA) or an Inherited Roth IRA. By completing this form, beneficiaries can ensure that the QPP death benefit is transferred in a manner that adheres to IRS guidelines and maintains the tax advantages of the rollover. It is crucial for beneficiaries to submit the form in a timely manner to preserve their rights to distribution options and comply with required tax withholding.

• 1. Deceased TRS Member Information: Includes the member's first name, middle initial, last name, date of birth, Social Security number (last 4 digits), TRS membership/retirement number, and date of death.
• 2. Beneficiary Information: Includes the beneficiary's TRS claim code, first name, middle initial, last name, permanent home address, city, state, zip code, country, email address, Social Security number, date of birth, relationship to deceased TRS member, and primary and alternate phone numbers.

Failure to submit this form may result in the forfeiture of rollover options and potential tax advantages. Beneficiaries may face mandatory lump-sum distributions and tax consequences.

• Loss of Rollover Eligibility: Missing the submission deadline can disqualify beneficiaries from rolling over the QPP death benefit.
• Tax Consequences: Failure to roll over the benefit may lead to mandatory lump-sum distributions subject to withholding and taxation.

• 1. Designated Beneficiary: If you are the designated beneficiary under the QPP of a deceased TRS member.
• 2. Inherited IRA/Roth IRA: When you want to roll over the lump-sum QPP death benefit to an Inherited IRA or Roth IRA.
• 3. Tax Withholding: If you need to manage tax withholding associated with a rollover to a Roth account.
• 4. RMD Payments: For spouse beneficiaries needing to continue or start receiving RMD payments as per IRS guidelines.
• 5. Satisfy IRS Requirements: To comply with IRS rollover and distribution rules, including partial distributions.