HomeMy WebLinkAboutOCDSB 198 - XY Application - ESP, PSSP, PSSU, PVP, UE form 2021APPLICATION FOR SELF-FUNDED LEAVE
(ESP, PSSP, PSSU, P/VP, UNION EXEMPT ONLY)
OCDSB Form 198 (X/Y A&S,U/E, P/VP Lv. Application) April 2021
Application
Deadline
Completed applications must be emailed electronically to Human Resources no later than
4:00 pm on: Jan 31st (PSSU); Mar 1st (ESP); May 1st (PSSP & P/VP); June 1st (U/E)
Eligibility To be considered for a self-funded leave, you must have been continuously employed with
the OCDSB as a Regular Employee for at least two (2) years at the commencement of your
self-funded leave (for Union-Exempt, at least three (3) years at the commencement of your
self-funded leave).
Income Tax
Act
Regulations
Plan
Restrictions
Collective
Agreement
Plan restrictions are as follows:
• Deferral of pay (tax deferred) over a set # of years leading up to the leave period. Deferrals
not to exceed 33 1/3% of gross annual salary in any 1 year and cannot exceed the
maximum 6-year limit.
• While on leave you cannot receive any salary or wages from the Ottawa-Carleton District
School Board (casual, occasional, term, cont. education, etc.) and cannot work under
contract with another Board, without permission from the OCDSB.
• 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.
• The requested deductions from your pay will commence effective this September 1st, and
will 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 on file with Payroll.
Plan Deferral Complete Form 199 (X/Y Lv. Notification) no later than March 1st prior to the start of the
scheduled leave year. Leave deferral is permitted for one year only and does not extend
contributions for an additional year. The 6/7 leave plan cannot be deferred.
Deduction
Adjustments Deductions can’t exceed the maximum contribution % in the original plan (e.g. 2/3 original
plan can’t exceed 33.3%).
P/VP – The percentage of salary to be deducted may be amended by mutual agreement in
writing, to be effective the following September 1st or January 1st, provided such requests are
received for approval by the preceding March 1st or the preceding October 1st respectively.
ESP, PSSU – The percentage of salary to be deducted may be amended by mutual
agreement in writing, to be effective the following September, provided such requests are
received for approval by the preceding March 1st
PSSP, U/E – No amendments to deductions are permitted.
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
Subject to the applicable collective agreement/handbook: The employee shall be returned to
the same position or, if not available, an equivalent position to that held at the time of the
commencement of the leave (subject to surplus/redundancy).
Benefits ESP, PSSP, PSSU – You are not eligible to continue LTD coverage during this leave. Your
Benefits Coverage (Health; Dental; Life Insurance) rests with OTIP. Once your leave begins,
it may take up to 1 month for OTIP to contact you. They can be reached at 1-866-783-6847.
P/VP & Union Exempt: Your benefits now rest with a Provincial Trust.
Pension OMERS: In accordance with the provisions of OMERS an employee may purchase credit for
the period of absence but must assume the full cost of the credit purchase.
TPP: 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/OMERS.
APPLICATION FOR SELF-FUNDED LEAVE
(ESP, PSSP, PSSU, P/VP, UNION EXEMPT ONLY)
OCDSB Form 198 (X/Y A&S,U/E, P/VP Lv. Application) April 2021
To Be Completed By Employee
Select Employee Group: ESP PSSP PSSU P/VP UNION EXEMPT
I, _____________________________________, wish to participate in the plan checked below:
1/2 years at 33.3%* or lesser amount of ____% 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 ____% 6/7 years at 14.0%* or lesser amount of ____%
NOTE: 4/5 means 4 years of deductions with the leave commencing in the 5th year
Plan Options: 1/2 and 6/7 not available for PSSP or U/E
*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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