HomeMy WebLinkAboutOCDSB 198 - XY Application - Secondary Academic form 2021APPLICATION FOR SELF-FUNDED LEAVE (SECONDARY TEACHERS)
OCDSB Form 198 (X/Y ACSEC Lv. Application) April 2021
Application
Deadline
Completed applications must be emailed electronically to the appropriate HR
Officer/Administrator no later than 4:00 p.m. May 1st.
Eligibility •To be considered for a self-funded leave, you must have been continuously employed
with the OCDSB as a Regular Day School Secondary Teacher for at least two (2) years
at the commencement of your self-funded leave, and
•Under the provisions of the Teachers' Pension Plan Act, as of 1 September 1992,
teachers must have been credited as a member in the Ontario Teachers' Pension Plan
for at least three full school years (30 months) before beginning the deferred or reduced
leave plan.
•To apply for a leave of six months, you must be assigned to a semestered school at
application & leave year. Semester 1 Leave period (August to January); Semester 2
Leave period (February to July).
Income Tax
Act/Regulations
Plan
Restrictions
Collective
Agreement
(Articles
L15 & L31)
Plan restrictions are as follows:
• Deferral of pay (tax deferred) over a set # of years leading up to the leave period. As
per CRA Regulations, deferrals are not to exceed 33 1/3% of gross annual salary in any
1 year and cannot exceed the maximum 6-year limit.
• In a semestered leave, you can accumulate the same amount of tax deferred dollars as
you can for a full year leave.
• While on self-funded leave you cannot receive any salary or wages from the Ottawa-
Carleton District School Board (occasional, contractual, cont. education, etc.)
• You must return to your regular employment with the Board after the leave for a period
of time that is not less than the period of leave (i.e. one school year or one semester
depending on the plan entered).
• The requested deductions from your pay will commence effective this September 1st,
and be deposited into a trust account, established for you, with the Ottawa-Carleton
Credit Union. You cannot place your funds into any other account nor negotiate the
interest rate.
Plan Withdrawal Complete OCDSB #199 form no later than March 1st prior to the start of the scheduled
leave year. The accumulated amount of deductions, plus accrued interest, less statutory
deductions, will be paid in one lump sum within 60 calendar days to your bank account.
Plan Deferral Complete Form 199 (X/Y Lv. Notification) no later than March 1st prior to the start of the
scheduled leave year. Deferral is permitted for one year only and does not extend
contributions for an additional year. The 6/7 leave plan cannot be deferred.
Leave Year
Disbursement of
Funds
Complete Form 199 (X/Y Lv. Notification) no later than May 1st prior to the start of leave
to confirm the dates and % of disbursement of accumulated funds. There shall be no
interruption to continuous service for seniority. You shall not accumulate further
experience during the period of leave.
Right of Return Your retain right of return upon completion of your X/Y leave year to the school from
which you left, subject to surplus/redundancy procedures.
Benefits You will be sent a benefits statement outlining your LTD coverage (if applicable) and will
be given the option of continuing or stopping LTD coverage during your leave. If
continuing, a monthly direct withdrawal (from the same account you receive your pay) will
be established to collect the premiums. Your benefits coverage (Health; Dental; Life
Insurance) rests with OTIP. You can contact them directly at 1-866-783-6847.
Pension During your "pay-in years" your pension continues to be based on your total annual salary
(before deductions). During your "leave period" your pension contributions are based on
your annual salary, deducted from your X/Y funds and remitted to Teachers Pension Plan
by the Board. There is no negative effect on your pension.
APPLICATION FOR SELF-FUNDED LEAVE (SECONDARY TEACHERS)
OCDSB Form 198 (X/Y ACSEC Lv. Application) April 2021
To Be Completed By Employee
I, _____________________________________, wish to participate in the plan checked below:
Full Year Semester 1 (August – January) Semester 2 (February – July)
2/3 years at 33.3%* or lesser amount of ____% 3/4 years at 25.0%* or lesser amount of ____%
4/5 years at 20.0%* or lesser amount of ____% 5/6 years at 16.6%* or lesser amount of ____%
NOTE: 4/5 means 4 years of deductions with the leave commencing in the 5th year
Self-funded leave requested to begin on __________________(YYYY/MM/DD)
*Figures represent % max of gross annual salary contribution.
I authorize the Ottawa-Carleton District School Board to effect these deductions commencing
September 1st and place these funds into an account with the Ottawa-Carleton Educational Credit
Union, as designated in accordance with the Collective Agreement.
Employee Signature EIN Work Location Date
Employee Information for Credit Union:
Employee Address (# Street, City, Province, Country, Postal Code) S.I.N.
To Be Completed by HR Officer/Administrator
The Employee’s leave will take place from ____ to ____ .
YYYYMMDD YYYYMMDD
Approved - Employee meets eligibility criteria; provide signed copy to Employee
Denied (email employee with reasons)
If Approved, fax signed copy to the Credit Union to open account (Fax # 613-238-9858)
HR Officer/Administrator Signature Date
To Be Completed by HR Operations
Empl
Group
Job
Code
Loc.
Cd.
EST
Cd.
Start
Date
End
Date FTE Reason
Cd.
PA
%
SE
%
VA
%
LV
YR RoR
1 X/Y 0 100 0 1.0
Y
N
Comments:
Copy on HR File Original To Audit Input: Audit:
To Be Completed by Payroll
Empl.
Group
Ded
Code Start Date End Date Per Pay % Leave Start Date Leave End Date
Comments:
Input: Audit:
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