CSS2HTML: WEB7216.XDP

COVID-19 Earnings Limitation Exception Certification
SC Public Employee Benefit Authority

202 Arbor Lake Drive

Columbia, SC 29223

Employee name

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 7216
Revised 9/24/2020
Sign 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.

EMPLOYEE INFORMATION

EMPLOYER INFORMATION

Employer name

Please contact PEBA's Customer Contact Center with any questions at 803.737.6800 or 888.260.9430, or www.peba.sc.gov.

Authorized representative (print name)

Authorized representative (signature)

Title/position

Date

Employer code

Pursuant to Section 5 of H. 4014 and Section 15 of H. 3210 of 2020:


For the period beginning March 19, 2020, and ending June 30, 2021, 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.

AUTHORIZATIONS

Position title

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.


Exemption explanation