Indiana University

IU 18/20 RETIREMENT PLAN
GAINFUL EMPLOYMENT CERTIFICATION
Period January 1, 2014 through June 30, 2014

REPORTABLE EARNINGS:

In accordance with University policy, IU 18/20 Retirement Plan (Plan) recipients cannot receive Plan benefits while receiving compensation from Indiana University or any other entity funded by the State of Indiana.

click for NO reportable earnings I had NO reportable earnings from Indiana University, any entity funded by the State of Indiana, or any not-for-profit organization that would appear to receive intermediary payments from Indiana University or the State of Indiana.
Please click button then complete and submit this page.
click if you had reportable earnings. this will take you to a new page. I had reportable earnings from Indiana University, an entity funded by the State of Indiana, or a not-for-profit organization that would appear to receive intermediary payments from Indiana University or the State of Indiana.
Please click button then complete and submit the next page.
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Complete the information below if you had NO reportable earnings (* = required field)

EMPLOYEE INFORMATION:

Name: *      

 *:

CERTIFICATION AND SIGNATURE:

I certify that to the best of my knowledge the above information is true and correct. I understand that falsification of information will result in the termination of my IU 18/20 Retirement Plan benefits. I understand, if requested by Indiana University, I must provide documentation of my reported earnings for all periods of time during which I received IU 18/20 Retirement Plan benefits and if this request is not fulfilled in a timely manner it will result in the termination of my IU 18/20 Retirement Plan benefits.

Typing my name in the space provided constitutes an electronic signature and certifies that the information supplied on this form is true and correct.

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University Human Resource Services
June 2014