SB64 (4/22) PAGE 1
COST LETTER REQUEST FORM
FOR TIERS III, IV, AND VI MEMBERS
File this form to request a Cost Letter for pension credit in TRS for the types of service listed below. The letter
will provide you with the cost of this credit and your payment options, but requesting the letter does not obligate
you to purchase the credit.
Prior service Creditable service that you performed with a New York City and/or New York State public
employer before joining TRS that was not transferred to TRS with your membership.
Note: To save time, you can instead submit a Cost Letter request for your prior service
in the secure section of our website.
Amann service Creditable service, such as regular substitute teaching or per diem service, that you performed
with a New York City or New York State public employer during a leave of absence from your
TRS-eligible position or after separating from service.
Do NOT le this form to claim pension credit for the following type of service:
● Military service. To claim credit, submit a “Military Service Credit Request Form” (code SD68).
Benets of Additional Service Credit
● You are not required to purchase credit for the service you indicate on this form. However, if you do, your
prospective service retirement allowance will be higher.
● If you are not vested, you may more quickly attain vested rights and qualify for retirement benets.
● If you are a Tier III or IV member, purchasing service credit may also enable you to more quickly attain
the years of credited service needed to stop or reduce your pension contributions.
Questions and Further Information
● For a breakdown of your Total Service Credit, consult your latest Annual Benets Statement (ABS),
which is available for viewing in the secure section of our website, or submit a “Total Service Letter
Request Form (For Tiers III, IV, and VI Members Only)” (code SB66).
● For more information about service credit, please refer to the FAQs on our website.
INSTRUCTIONS
PLEASE READ CAREFULLY
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SB64 (4/22) PAGE 2
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SB64 (4/22) PAGE 3
COST LETTER REQUEST FORM
FOR TIERS III, IV, AND VI MEMBERS
First Name MI Last Name Social Security Number (last 4 digits only)
Permanent Home Address Apt. No. TRS Membership Number
City State Zip Code Primary Phone Number (Check one: Home Work Mobile)
Email Address Alternate Phone Number (Check one: Home Work Mobile)
( )
( )
X
XXXX
Please read the instructions on page 1 before completing this form.
(NOTE: Please print in black or blue ink, and initial any changes that you make on this form.)
PART A: Please provide the information below.
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PART B: Indicate the type and period(s) of service for which you are requesting credit, and write your initials in the space provided.
If you intend to retire within the next 12 months, indicate your expected date of retirement.
Expected date of retirement (if applicable):
I request that TRS send me a Cost Letter to purchase credit for the type of service I have indicated below.
____ Prior service
Period: From To
Employer’s name and address:
Period: From To
Employer’s name and address:
Check here if you entered new contact information above. TRS will then update our records based on what you entered.
Please keep your contact information up to date. You can visit our website to update your contact information anytime, or le a
“Member’s Change of Address Form” (code DM13) with TRS.
SB64 (4/22) PAGE 4
____ Prior service (continued)
Period: From To
Employer’s name and address:
Period: From To
Employer’s name and address:
____ Amann service
Period: From To
Employer’s name and address:
Period: From To
Employer’s name and address:
PART C: Please read the statement and sign and date below. If you are an agent/legal representative signing on the member’s
behalf, please indicate this.
I hereby request that TRS send me a Cost Letter for the periods of service I indicated in Part B. I understand that I am not required
to purchase credit for this service, but that doing so will increase my prospective service retirement allowance. I afrm that, to the
best of my knowledge, all information I have provided above is true and correct.
If signing as an agent, I certify that I have no knowledge or notice that my authority as the member’s agent has ended by revocation,
termination, death, divorce, or otherwise.
CHECK HERE IF YOU ARE SIGNING AS AN AGENT.
YOUR SIGNATURE YOUR PRINTED NAME DATE (MM/DD/YYYY)
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