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Pa community service form print out

278 052013 form fillable 2026

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The document provides guidelines for Pennsylvania Public School Employees' Retirement System (PSERS) members on how to purchase credit for out-of-state service. It outlines eligibility requirements, application procedures, cost calculations based on membership class, and responsibilities for payment. Members must certify their ineligibility for retirement benefits from other pension funds based on out-of-state service and provide necessary information from previous employers. The document emphasizes the maximum allowable purchase of 12 years of out-of-state or government service.

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Click ‘Get Form’ to open the 278 052013 form in the editor.
Begin with Section A, 'Member Information.' Fill in your personal details such as name, Social Security number, and contact information. Ensure accuracy as this data is provided to PSERS through your employer.
Move to Section B, 'Member Certification.' Here, you must sign and date the form, certifying your eligibility for purchasing out-of-state service credit. Review the statements carefully before signing.
In Section C, 'Employment Information,' provide details of your out-of-state service. Your previous employer must complete this section accurately for each school year of service.
Proceed to Section D for 'Employer Certification.' This section requires your employer's signature and date to confirm the accuracy of the employment information provided.
Complete Sections E through H based on your retirement plan type. Ensure all necessary signatures are obtained before submitting the form.

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