Form my|CalPERS1068 "Community Property Retirement Allowance Estimate Request" - California

What Is Form my|CalPERS1068?

This is a legal form that was released by the California Public Employees' Retirement System - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2021;
  • The latest edition provided by the California Public Employees' Retirement System;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form my|CalPERS1068 by clicking the link below or browse more documents and templates provided by the California Public Employees' Retirement System.

ADVERTISEMENT
ADVERTISEMENT

Download Form my|CalPERS1068 "Community Property Retirement Allowance Estimate Request" - California

Download PDF

Fill PDF online

Rate (4.5 / 5) 34 votes
Community Property Retirement Allowance
Estimate Request
888 CalPERS (or 888-225-7377) • TTY: (877) 249-7442
This is a request for an estimate of potential future retirement benefit amounts. To use this form,
we must have an acceptable filed court order for a time rule division (Model Order B) on file and
the request must be within three years of the anticipated retirement date. You are limited to two
estimate requests within a 12-month period. See the back of this form for instructions.
Information About You
Section 1
Check the box that applies to you:
 Member - Complete sections 1, 3 and 4.
 Nonmember Spouse - Complete sections 1 and 2.
Your estimate will be
Social Security Number or CalPERS ID
Your Name (First Name, Middle Initial, Last Name)
mailed to the address
provided on this form.
If you need to update
(
)
your address, see the
Birth Date (mm/dd/yyyy)
Daytime Phone
back of this form for
instructions.
Address
State
Zip
City
Member Information
Section 2
Social Security Number or CalPERS ID
Member's Name (First Name, Middle Initial, Last Name)
Member's Anticipated Retirement Date:
Date Required (mm/dd/yyyy)
Nonmember Spouse Information
Section 3
Birth Date Required (mm/dd/yyyy)
Former Spouse/Domestic Partner's Name (First Name, Middle Initial, Last Name)
Retirement Information
Section 4
Choose one retirement type:
 Service Retirement
 Disability Retirement
 Industrial Disability Retirement
Projected retirement date:
Date Required (mm/dd/yyyy)
Employer
Position Title
To include unused sick leave and/or educational leave on the retirement estimate, complete the following
information:
Sick Leave Hours
Educational Leave Hours
Is there an eligible survivor?
 Yes
 No
What is a survivor vs. a
beneficiary? See the
How many beneficiaries do you want to include in the estimate?
back of this form for
details and a complete
c None
description of the
c One or more and with a specific dollar or specific percentage amount to each beneficiary.
available retirement
(Complete the information in the spaces provided below.)
payment options.
Birth Date (mm/dd/yyyy)
Dollar or Percent of Benefit
Birth Date (mm/dd/yyyy)
Dollar or Percent of Benefit
Birth Date (mm/dd/yyyy)
Dollar or Percent of Benefit
Birth Date (mm/dd/yyyy)
Dollar or Percent of Benefit
If you are a member of another California public retirement system and want us to use your final
compensation with the other system in your estimate, complete the information below.
Name of Reciprocal System
Estimated Final Compensation Amount
CalPERS Retirement Benefit Services Division • Attn: Community Property Unit • P.O. Box 2056, Sacramento, California 95812-2056
Mail to:
my|CalPERS 1068 (Rev 6/2021)
Page 1 of 2
Community Property Retirement Allowance
Estimate Request
888 CalPERS (or 888-225-7377) • TTY: (877) 249-7442
This is a request for an estimate of potential future retirement benefit amounts. To use this form,
we must have an acceptable filed court order for a time rule division (Model Order B) on file and
the request must be within three years of the anticipated retirement date. You are limited to two
estimate requests within a 12-month period. See the back of this form for instructions.
Information About You
Section 1
Check the box that applies to you:
 Member - Complete sections 1, 3 and 4.
 Nonmember Spouse - Complete sections 1 and 2.
Your estimate will be
Social Security Number or CalPERS ID
Your Name (First Name, Middle Initial, Last Name)
mailed to the address
provided on this form.
If you need to update
(
)
your address, see the
Birth Date (mm/dd/yyyy)
Daytime Phone
back of this form for
instructions.
Address
State
Zip
City
Member Information
Section 2
Social Security Number or CalPERS ID
Member's Name (First Name, Middle Initial, Last Name)
Member's Anticipated Retirement Date:
Date Required (mm/dd/yyyy)
Nonmember Spouse Information
Section 3
Birth Date Required (mm/dd/yyyy)
Former Spouse/Domestic Partner's Name (First Name, Middle Initial, Last Name)
Retirement Information
Section 4
Choose one retirement type:
 Service Retirement
 Disability Retirement
 Industrial Disability Retirement
Projected retirement date:
Date Required (mm/dd/yyyy)
Employer
Position Title
To include unused sick leave and/or educational leave on the retirement estimate, complete the following
information:
Sick Leave Hours
Educational Leave Hours
Is there an eligible survivor?
 Yes
 No
What is a survivor vs. a
beneficiary? See the
How many beneficiaries do you want to include in the estimate?
back of this form for
details and a complete
c None
description of the
c One or more and with a specific dollar or specific percentage amount to each beneficiary.
available retirement
(Complete the information in the spaces provided below.)
payment options.
Birth Date (mm/dd/yyyy)
Dollar or Percent of Benefit
Birth Date (mm/dd/yyyy)
Dollar or Percent of Benefit
Birth Date (mm/dd/yyyy)
Dollar or Percent of Benefit
Birth Date (mm/dd/yyyy)
Dollar or Percent of Benefit
If you are a member of another California public retirement system and want us to use your final
compensation with the other system in your estimate, complete the information below.
Name of Reciprocal System
Estimated Final Compensation Amount
CalPERS Retirement Benefit Services Division • Attn: Community Property Unit • P.O. Box 2056, Sacramento, California 95812-2056
Mail to:
my|CalPERS 1068 (Rev 6/2021)
Page 1 of 2
Information About You
Section 1
 If you are an active CalPERS member, contact your personnel office and ask them to update your mailing
address with us.
 If you are an inactive CalPERS member, update your address at my.calpers.ca.gov or call us toll free
at 888 CalPERS
(or 888-225-7377).
 If you are nonmember spouse, call us toll free at 888 CalPERS (or 888-225-7377).
M
ember Information
Sectio n 2
Co
mplete all fields.
Section 3
N
onmember Spouse Information
Co
mplete all fields.
Section 4
R
etirement Information
Pr
ojected Retirement Date - Your retirement date can be no earlier than your last day on payroll. If it has been
more than nine months since you left employment, the date you enter cannot be earlier than the first day of the
month you submit this form.
Unused Sick Leave/Educational Leave - We will only include this in your retirement estimate if your employer
contracts to provide this benefit.
What is a survivor? - A survivor receives a monthly benefit regardless of the retirement payment you choose.
We only include this in your retirement estimate if your employer contracts to provide this benefit. A survivor is
defined by law as:
 a spouse or registered domestic partner who was married or registered to you for at least one year before
your service retirement date and continuously until your death. (For disability or industrial disability
retirement, these conditions must be met on or before the effective date of your disability or industrial
disability retirement.)
 natural or adopted unmarried children under age 18.
 an unmarried child who was disabled prior to age 18 and whose disability continues without interruption
until the disability ends or until marriage.
 qualifying financially dependent parents, if none of the above.
What is a beneficiary? - A beneficiary is any person you choose to receive either a one-time lump-sum
payment or ongoing monthly benefit upon your death.
Retirement Options - When you retire, you will choose one of the following retirement options and name
a beneficiary for your share of the benefit.
 Court-Ordered Community Property Option 4 / Unmodified Allowance - Provides an ongoing
monthly benefit to your nonmember spouse equal to his or her community property interest.
For your remaining share, provides you the highest monthly allowance paid for your lifetime. There
is no return of unused member contributions upon your death.
 Court-Ordered Community Property Option 4 / Return of Remaining Contributions Option 1 -
Provides an ongoing monthly benefit to your nonmember spouse equal to his or her community
property interest.
For your remaining share, provides a lump-sum payout of any remaining member contributions in
your account to one or more named beneficiaries.
 Court-Ordered Community Property Option 4 / Specific Percentage or Specific Dollar Amount
Provides an ongoing monthly benefit to your nonmember spouse equal to his or her community
property interest.
For your remaining share, provides an ongoing monthly benefit of a specific percentage or specific
dollar amount of your retirement benefit to one or more named beneficiaries upon your death.
Reciprocity - Enter the name of the other California public retirement system you are a member of and your
highest average annual compensation for any consecutive 12-or 36-month period of employment with the
other retirement system.
To be eligible for full reciprocal benefits, such as final compensation exchange, you must retire concurrently.
Refer to the When You Change Retirement Systems (PUB 16) publication for detailed information.
my|CalPERS 1068 (Rev 6/2021)
Page 2 of 2
Privacy Notice
The privacy of personal information is of the utmost importance to CalPERS.
The following information is provided to you in compliance with the Information
Practices Act of 1977 and the Federal Privacy Act of 1974.
Information Purpose
Social Security numbers are used for the
following purposes:
The information requested is collected pursuant
1.
Enrollee identification
to the Government Code (sections 20000 et seq.)
2. Payroll deduction/state contributions
and will be used for administration of Board
3. Billing of contracting agencies for employee/
duties under the Retirement Law, the Social
employer contributions
Security Act, and the Public Employees’ Medical
4. Reports to CalPERS and other state agencies
and Hospital Care Act, as the case may be.
5. Coordination of benefits among carriers
Submission of the requested information is
6. Resolving member appeals, complaints,
mandatory. Failure to comply may result in
or grievances with health plan carriers
CalPERS being unable to perform its functions
regarding your status.
Information Disclosure
Please do not include information that is
Portions of this information may be transferred
not requested.
to other state agencies (such as your employer),
physicians, and insurance carriers, but only
Social Security Numbers
in strict accordance with current statutes
regarding confidentiality.
Social Security numbers are collected on a
mandatory and voluntary basis. If this is CalPERS’
Your Rights
first request for disclosure of your Social Security
number, then disclosure is mandatory. If your
You have the right to review your membership
Social Security number has already been provided,
files maintained by the System. For questions
disclosure is voluntary. Due to the use of Social
about this notice, our Privacy Policy, or your rights,
Security numbers by other agencies for
please write to the CalPERS Privacy Officer at
identification purposes, we may be unable to
400 Q Street, Sacramento, CA 95811 or call us
verify eligibility for benefits without the number.
at 888 CalPERS (or 888-225-7377).
May 2016
Page of 3