When you terminate employment, one of your 4 options regarding retirement is to withdraw the employee retirement contributions you’ve paid into ACERA with each paycheck during your career as an ACERA member. To withdraw your contributions, use the Termination Election Form.

Download the Termination Election Form

Termination Election Form Instructions

If you wish to defer ACERA membership…

• Elect to defer your membership by checking box 1.

• Return your form to ACERA within 90 days of your termination date.

If you wish to establish reciprocity with another retirement system…

• Elect to establish reciprocity by checking box 2, and write in the name of your new employer’s retirement system.

• Return your form to ACERA within 30 days of your termination date.

• (Note: More than 12 weeks of overlapping service in two agencies may disqualify you for reciprocity.)

If you wish to end ACERA membership and withdraw your contributions…

• Elect to withdraw your contributions by checking box 3.

• Select whether you want A.) a refund, B.) to rollover your funds to another pre-tax retirement account, or C.) a combination of the two.

  • Your refund may be paid directly to you in a lump sum. When you choose a lump sum, ACERA is required to withhold federal income tax at the rate of at least 20% from the taxable portion of all lump sum distribution. ACERA is also required to withhold California state income tax at the rate of 2% from the taxable portion of your distribution unless you elect otherwise. Additionally, if you’re under 59 1/2, both the Federal and State governments may assess penalties for “early withdrawal from a retirement account.” The taxes and penalties may add up to as much as 33%. ACERA cannot pay your refund sooner than 30 days from the date of termination. Expect 30 to 60 days for funds to be disbursed.
  • Your refund may be paid through a direct rollover to another eligible retirement account. When you choose a direct rollover, your account balance may be disbursed as follows:
    • Pre-tax contributions and interest may be rolled over into an eligible retirement account, such as an IRA or another employer’s eligible retirement plan.
    • After-tax contributions may be rolled over into a Roth IRA. You may choose the amounts to be rolled over into each account;

• For refunds, make sure to indicate the percentage you want us to withhold for income taxes.

• For rollovers, make sure the information about the institution you’re rolling funds into is completely correct.

You may choose to have certain amounts of pre-tax or after-tax funds paid directly to you. Keep in mind that pre-tax disbursements will be subject to tax withholding.

Complete Section 4

• Complete Section 4 of the form—in most cases, your spouse or domestic partner must acknowledge your election.

Complete Section 5

• If your Total Balance is less than $10,000 you must attach a copy of a valid (not expired) photo identification.
• If your Total Balance is $10,000 or more, you MUST get the form notarized.

Complete Section 6

Complete Section 6 by reading the acknowledgement and signing and dating the form. 

Submit Your Form

Follow the instructions on the How to Submit Forms to ACERA page. Note that if you are electing to Withdraw Your Contributions (Refund and/or Rollover), you must submit the original signed copy either via QIC, mail, or our office drop box. You can’t send a fax or scan and upload the form.