COVID-19 Earnings Limitation Exception CertificationSC Public Employee Benefit Authority
202 Arbor Lake Drive
Columbia, SC 29223
Social Security number (Last 4 only)
THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS AND DOES NOT CREATE A CONTRACT BETWEEN THE MEMBER AND THE SOUTH CAROLINA PUBLIC EMPLOYEE BENEFIT AUTHORITY. THE SOUTH CAROLINA PUBLIC EMPLOYEE BENEFIT AUTHORITY RESERVES THE RIGHT TO REVISE THE CONTENT OF THIS DOCUMENT.
Form 7216Revised 6/24/2022Sign in blue or black ink
Date of hire
As an authorized representative of the employer listed above, I certify that the above-referenced retired member of SCRS or PORS
is employed by this employer to participate in the state's public health preparedness and response to the COVID-19 virus.
Please contact PEBA's Customer Service with any questions at 803.737.6800 or 888.260.9430, or www.peba.sc.gov.
Authorized representative (print name)
Authorized representative (signature)
Pursuant to Proviso 108.12 of Part IB of H. 5150 of 2022:
For fiscal year 2022-2023 (i.e., July 1, 2022, through June 30, 2023), the earnings limitation imposed pursuant to Section 9-1-1790 and Section 9-11-90 of the South Carolina Code does not apply to retired members of the South Carolina Retirement System (SCRS) or the Police Officers Retirement System (PORS) who return to covered employment to participate in the state's public health preparedness and response to the COVID-19 virus.
Please complete and email this form to PDept@peba.sc.gov.
Pursuant to the legislation, to qualify for the exemption, the return to covered employment must be "to participate in the state's public health preparedness and response to the COVID-19 virus." The exemption is not for all employment during the COVID crisis, but only employment that involves participation in the public health response. PEBA may reject this request if the employer can not establish how the position would qualify for the exception.
Scripting must be enabled for this form to work correctly.