| Add Firefighter | Select the Add Firefighter button. This will open a popup window to enter a firefighter’s data. |
| Benefit Type | Select a benefit type from the dropdown list. Retirement: Firefighter separated from active service and received lump sum payment at age 50 or over. Disability: Firefighter received lump sum payment earlier than age 50 due to disability. Survivor: Firefighter’s qualified survivor received lump sum payment. For supplemental survivor benefits, qualifying survivors include: - Surviving spouse, and if none
- Surviving child or children, and if none
- Designated beneficiary, or if no beneficiary designated
- Estate of deceased active or deferred firefighter
Termination: This should only be used if the relief association has dissolved or is in the process of dissolving, and only if the firefighter had fewer than five years of active service or five years of active membership. |
| First Name | Enter the firefighter’s first name. |
| Last Name | Enter the firefighter’s last name. |
| Date of Birth | Enter the firefighter’s date of birth. |
| Years of Active Service | Enter the number of years that the volunteer firefighter served as an active member of the fire department with which the relief association is associated, rounded to the nearest year. Except in the cases of disability or survivor benefits, this must have been at least five full years in order to receive a lump sum service pension. |
| Years of Active Membership | Enter the number of years that the volunteer firefighter was an active member of the relief association prior to separation from active service with the municipal fire department or independent nonprofit firefighting corporation, rounded to the nearest year. Except in the cases of disability or survivor benefits, this must have been at least five full years in order to receive a lump sum service pension. |
| Lump Sum Amount | Enter the dollar amount of the lump sum service pension paid to the volunteer firefighter by the relief association. Enter the original lump sum amount on which the supplemental benefit was based. This is the amount before adding any interest accrued during the time of a deferral and before deducting any income taxes paid. Do not include the supplemental benefit in this amount. |
| Lump Sum Date Paid | Enter the date the lump sum was paid to the firefighter. This must be a date between January 1, 2019, and December 31, 2023. |
| Supplemental Benefit Amount | Enter the dollar amount of the supplemental benefit paid to the volunteer firefighter by the relief association. - For retirement, disability, and dissolution, the supplemental benefit is 10% of the original lump sum service pension, up to $1,000.
- For a supplemental survivor benefit, the supplemental benefit is 20% of the original lump sum service pension, up to $2,000.
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| Supplemental Benefit Paid Date | Enter the date the supplemental benefit was paid to the firefighter. This must be a date between January 1, 2019, and December 31, 2023. |
| Save | Select the Save button to save the data you have entered. |
| Repeat for Additional Firefighters | Select the Add Firefighter button and repeat entering the firefighter payment information until all firefighters have been added to the form. When all have been added, you can continue to the Certification section. |
