T215 Past Service Pension Adjustment (PSPA) Exempt from Certification or Permitted Corrective Contribution (PCC)

Completed by a plan administrator when the total of the exempt PSPA, or the difference between the original PSPA and amended PSPA, is equal to or greater than $50.

Ways to get the form

• Download and fill out with Acrobat Reader

  You must download and open fillable PDFs in Acrobat Reader 10 or higher.

  • Accessible Fillable PDF (t215-fill-24e.pdf)

• Print and fill out by hand

  • Standard print PDF (t215-24b.pdf)

• Ask for an alternate format

  You can order alternate formats such as digital audio, electronic text, braille, and large print.

  • Order alternate formats for persons with disabilities