Completion Instructions for Retired Staff Data Form

This form is used to create the payroll/personnel record for a University employee. For more information on completing the PAF, see the PAF on-line guide. If you have questions about completing the form, contact your campus Human Resources Office for assistance.

1. The legal name of the individual as it appears on the Social Security card, e.g.
   • Smith Jr, John     Baker-Brown, Erin      Brown, Samuel L
2. An eight-digit number assigned automatically by the PeopleSoft system. It will be used as the unique identifier for each employee,
   • e.g., 01000444
3. Enter social security number. Must be the same as recorded on the W-4 Form, e.g. 000-00-0000.
4. Check (X) the box that describes marital status.
5. Write in the address where the individual resides.
6. Write in home telephone number, including area code. Example: (573) 555-0000
7. Check (X) the box that indicates gender.
8. Write in the date born. Example: 12/01/1963 for December 1, 1963
9. The date the personnel action is effective. (mm/dd/yyyy)
10. Defines the action being taken.
11. Defines the reason for the action being taken. Record the appropriate code that corresponds to the reason for the action.
12. The five-character code that identifies the campus/business unit, UWIDE.
13. This alpha code identifies the specific department, URETIRE.
14. The four-digit code assigned to the job title, 9998.
15. Describes the benefit eligibility of the person. "Regular" all benefit eligible persons. "Temporary" all non-benefit eligible persons. "Full-time" a job with 1.00 FTE and 40 Standard Hours. "Part-time" a job with less than 1.00 FTE and less than 40 Standard Hours. Employee Class will be Retiree; check the box.
16. The average number of hours the employee is expected to work each week.
17. The full time equivalent of effort for the employee. FTE must be consistent with the standard hours, e.g. 1.00, .50
18. The code that describes the structure of the compensation. Choose one: RET, DEF, BEN.
19. Defines the holiday schedule of the employee. Choose "None" not eligible for University Holiday Schedule
20. Check "S" compensation frequency is monthly.
21. The county where the job is located, Boone County, 010.
22. Identifies FICA eligibility. Choose "E" exempt from FICA.
23. Indicates the manner in which the appointment will be paid: Choose "Monthly/NAANNL.
24. Record the monthly rate the person will receive.
25. Write in "M" for monthly paid persons.
26. Record Benefit Base amount at the time of retirement.
27. Enter the date this person is eligible to participate in Benefit Plans.
28. Benefit Record Number, 99.
29. Benefit Eligibility Fields - check the box if applicable to the retiree; leave the box blank for system default.
    1. Medicare Eligible
       N = None, default
       Medicare = eligible for Medicare reimbursement
    2. Employer Subsidy for Medical & Dental Rates 
       N = None, default
       R1 = retired on/after 9/1/1990 and age +yrs svc < 75 
       R2 = retired on/after 9/1/1990 with 75<=age + yrs svc <90 
       R3 = retired on/after 9/1/1990 with age + yrs svc>=90 
       R9 = eligible for pre 9/1/1990 subsidy
       B1 = beneficiary eligible because retiree retired on/after 9/1/1990 
          With age + yrs svc <75 
       B2 = beneficiary eligible because retiree retired on/after 9/1/1990 
          With 75<=age + yrs svc<90 
       B3 = beneficiary eligible because retiree retired on/after 9/1/1990 
          With age + yrs svc >=90 
       B9 = beneficiary eligible because retiree was eligible for pre 9/1/1990 
          Subsidy
    3. Accelerated death benefit life plans 
       N = None, default 
       A = Eligible for Plan Type 20s and Benefit Plan = RLF80A (closed block Of pre 12/1/1980 retirees)
       B = Eligible for Plan Type 20s and Benefit Plan = RLF80B (closed block Of pre 12/1/1980 retirees) 
       C = Eligible for Plan Type 20s and Benefit Plan = RLF80C (closed block Of pre 12/1/1980 retirees 
       Y= Eligible for Plan Type = 20s and Benefit Plan = LAD A, LAD B or LADBAT
    4. Retiree eligibility for Medical and/or Dental Plans 
       N = None, default 
       1 = Medical only, no dental 
       2 = Dental only, no medical 
       3 = Both medical and dental
    5. Retirees eligible for Humana, OOA-Choice or both medical plans 
       N = None, default 
       1 = Humana only 
30. Enter the date this person is assigned to a particular University Benefit Program.
31. Enter the code that is used to represent the University Benefit Plan assigned to this person.
32. The date this particular line of funding begins. (mm/dd/yyyy)
33. The five-character code that identifies the campus/business unit associated with this line of funding, UWIDE.
34. The alpha code for the department associated with this line of funding, URETIRE.
35. The four-character code assigned to the job title associated with this line of funding, 9998.
36. For monthly paid persons only - the amount the person is paid from this line of funding each month.
37. The five-character alpha/ numeric code assigned by finance that represents the chartfield string of the cost center to be charged, U0134.
38. The six-digit GL Account associated with the job code, 833600.
39. The three-character code that identifies the type of pay, e.g. NRT.
40. The beginning dollar amount to be paid to the survivor when the retiree dies.
41. The beginning dollar amount to be paid to the retiree when the joint annuitant dies, and the pension changes to Single Life Annuity with guaranteed period.
42. The date on which the Guaranteed Period ends.
43. The date on which the next Guaranteed COLA pension increase is scheduled to begin.
44. The original benefit eligibility date of the retiree. This date determines the beneficiary's eligibility for Ad-hoc COLA pension increases.
45. The date the employee begins retirement, or the date when the beneficiary is eligible for pension benefits.
46. A code used to designate the payment election designated by the retiree for pension payments.
47. A code used to designate the Guaranteed COLA option elected; this will be used to calculate future pension amount increases.
48. The alpha code that designates the campus/business unit where the individual was last employed.
49. The date the comments were prepared.
50. Name of the person who prepared the comments.
51. Descriptive and explanatory remarks concerning this retirement action.
52. Name of the person who prepared this form.
53. Date the form was prepared.