Haw. Code R. § 6-26-3

Current through April, 2024
Section 6-26-3 - Contents of application
(a) All applications for retirement benefits shall contain the following information:
(1) The member's name, mailing address, and social security number;
(2) The date of the application;
(3) The member's date of birth;
(4) The name of the employing department;
(5) The position or job title held by the member;
(6) The retirement allowance option that the member elects under any of the plans for receiving retirement allowances described in sections 88-74, 88-83, 88-282, 88-283, 88332, and 88-333, HRS;
(7) The name, relationship, social security number, and date of birth of any beneficiary designated to receive the benefit payable upon the death of the member after retirement;
(8) The duly notarized signature of the member is required unless:
(A) The member executes the application in the presence of a staff member who is authorized by the executive director of the system to accept applications; or
(B) The application is for ordinary or service-connected disability retirement and is filed by the member's duly authorized and appointed guardian or legal representative, as provided in section 6-26-1 (b) .
(b) If the application is for disability retirement, the application shall contain the following additional information:
(1) Whether the application is for ordinary or service-connected retirement.
(2) If the application is for service-connected disability retirement, a brief statement of the accident causing the disability, including the date, time, place, and circumstances of the accident, or a brief statement of the occupational hazard causing the disability.
(c) If the application is for service retirement, the application shall also contain the effective date of retirement.

Haw. Code R. § 6-26-3

[Eff 2/9/89; am and comp NOV 26 2009] (Auth: HRS § 88-28) (Imp: HRS §§ 88-73, 88-75, 88-79, 88-83, 88-281, 88-283, 88-28488-286, 88-331, 88-333, 88-334, 88-336)
Comp 4/11/2022