Change of Address Form
Short Term Disability Form for Active Participants (Weekly Accident and Sickness Benefit)
Reimbursement and Subrogation Agreement
Participant & Dependent Record
CVS/Caremark Temporary ID
Beneficiary Designation Form
It is important that you notify the Fund Office as soon as possible if any of the following occurs:
Annual Certifications and Annual Certifications from Industry Employment are mailed in April of each year. All pension benefit recipients must complete the Certification with proper notarization and return it to the Fund Office annually. Failure to return the Certification will result in the suspension of your benefit payments.
It is important to keep the Fund Office immediately aware of any address changes.
You may elect to have Federal Tax Withholding deducted from your monthly pension payments.
Withholding is one way for you to pay a portion of your income tax. If no tax, or not enough tax, is withheld from your benefits, you may have to pay estimated taxes during the year or a tax penalty at the end of the year. Of course, whether you have to pay federal income tax on your pension payments depends on the total amount of your taxable income. Remember, for most people, Social Security benefits are not taxable.
If you would like to have Federal Withholding deducted from your pension payment or would like to change the amount withheld, you can obtain the form on this website or call the Fund Office for a form.
W-4 Federal Tax Withholding
Electronic Funds Transfer direct deposit of your monthly pension payments is our required form of payment. Electronic Funds Transfer is a method of depositing funds to your bank account via computer, eliminating postal service delays and the potential for lost checks.
EFT is recognized as the most secure and convenient means of receiving recurring monthly benefit payments. In fact, Social Security now requires all benefit recipients to receive their payments electronically.
Electronic Funds Transfer Direct Deposit Form
1099R Tax Forms are mailed by January 31st of each year to the address on file.
Your pension payments are considered taxable income for federal purposes. As such, you may elect to have Federal Withholding deducted from your monthly pension payments.
Withholding is one way for you to pay a portion of your income tax. If no tax, or not enough tax, is withheld from your benefits, you may have to pay estimated taxes during the year or a tax penalty at the end of the year. Of course, whether you have to pay federal income tax on your pension payments depends on the total amount of your taxable income.
Unless otherwise elected, you will be considered the authorized representative for your dependent spouse and children and your dependent spouse will be considered the authorized representative for you and any dependent children.
Personal Representative Form
If you become totally and permanently disabled, you may qualify for a disability pension as long as:
~ you have at least 15 years of benefit service before your disability begins;
~ your disability continues for at least 26 consecutive weeks after your covered employment ends due to that disability;
~ you apply for a disability pension in writing within seven months of your disability; and
~ you became disabled while in covered employment.
To be considered totally and permanently disabled, you must submit evidence satisfactory to the Trustees of your disability. Evidence may be in the form of medical records, test and operative reports and physician statements for review by the Fund’s Medical Director. You must execute medial release forms that will be forwarded to all your physicians.
Disability Medical Release Form
A QDRO is a legal order resulting from a divorce or legal separation that gives the divorced spouse or other dependent (alternate payee), their share of an asset, such as a pension or retirement plan benefit.
The Fund does not write the QDRO. This must be done by you or your attorney. The QDRO must comply with the Plan’s procedures for administering a QDRO and must be entered by a court.
The Fund has specific procedures for administering a QDRO. To assist you or your attorney, the Fund has provided sample model language. You are encouraged to submit a draft order to the Fund for review prior to its entry in Court.
The model QDRO is for use under a Shared Payment Approach, Separate Interest Approach or for child support.
Please note that the Plan’s legal name and address are:
Local 705 International Brotherhood of Teamsters Pension Plan
1645 West Jackson Boulevard
Chicago, IL 60612
The Plan Administrator is Jack Witt.
You should be aware that when your draft Order is received by the Pension Fund, it will be reviewed and, when appropriate, recommended to the Board of Trustees for their approval.
Further note that the Fund will not release any information with respect to our Participant’s pension benefits without her/his written authorization, or unless required by subpoena.
Qualified Domestic Relations Orders Form