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All forms are fillable and ready for download and printing. VRS accepts all forms by mail or fax. Fax to: 804-786-9718. If on deadline when faxing a form, please call or email to alert VRS of its pending arrival. VRS does not accept forms via email, which is not a secure form of communication.

Form # Description Last Updated Link
n/a Approved Domestic Relations Orders - Defined Benefit Plan
08/2019Download
n/a Approved Domestic Relations Orders - Defined Contribution Account(s)
08/2019Download
All Hybrid Forms for Members
Link
All Hybrid Forms for Employers
Link
All Securian Financial/VRS Life Insurance Forms:
VRS-31, VRS-32, VRS-35, VRS-37, VRS-38, VRS-39, VRS-39A, VRS-39R and
VRS Certificate of Life Insurance.
Link
IRS 402(f) IRS 402(f) ‐ Special Tax Notice ‐ VRS Defined Benefit Plans
Before taking a refund, read this notice, which explains the tax consequences of taking a refund versus direct rollover into another plan.
10/2020Download
t-20879 State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants
03/2020Download
vsdp-2 College and University Opt-Out Form
09/2011Download
vrs-2 Designation of Beneficiary
VRS members and retirees now update beneficiaries online through their secure myVRS account.
07/2021Download
vrs-2a Designation of Beneficiary - Continuation
VRS members and retirees now update beneficiaries online through their secure myVRS account.
02/2020Download
vrs-3a Name and Address Declaration For Deferred Members
02/2011Download
vrs-3orp Request for Transfer of Funds to ORP
07/2019Download
vrs-5 Application for Service Retirement
Before completing the form, log in to myVRS for retirement counseling resources and review the Apply for Retirement page to determine if you can retire online.
09/2021Download
vrs-6 Application for Disability Retirement
05/2020Download
vrs-6a Explanation of Disability
01/2019Download
vrs-6b Physician's Report
01/2019Download
vrs-6c Request for Estimate of Disability Retirement Benefits
02/2011Download
vrs-6d Employer Information for Disability Application
10/2020Download
vrs-6e Certification of Alternate Employment for Disability Retiree for Political Subdivision Hazardous Duty Employees
08/2012Download
vrs-7orp Notice of Return to Covered Employment Optional Retirement Plan Retiree
11/2012Download
vrs-8 Certification of Exception from General Early Retirement Provisions
07/2013Download
vrs-11 Employer Certification of Involuntary Separation Under the Workforce Transition Act
02/2016Download
vrs-11a Employer Certification of Basic Group Life Insurance Coverage Under Workforce Transition Act
02/2011Download
vrs-11b Employer Certification of Involuntary Separation Under the Transitional Benefits Program
06/2015Download
vrs-11c Employer Certification of VRS Basic Group Life Insurance Coverage Under the Transitional Benefits Program
02/2011Download
vrs-15 Request for Income Tax Withholding
08/2020Download
vrs-26 Application for Purchase of Prior Service Credit
08/2017Download
vrs-26c Authorization for After-Tax Payroll Deduction to Purchase Service Credit
VRS members now select payment agreement type in myVRS and provide confirmation details page to employer.
Link
vrs-26e Agreement for Pretax Salary Reduction to Purchase Service Credit
VRS members now select payment agreement type in myVRS and provide confirmation details page to employer.
Link
vrs-26h Application to Purchase Prior Service Credit (For Superintendents of Schools)
02/2011Download
vrs-45 Request for Health Insurance Credit
Retirees can update health insurance policy information online through myVRS.
07/2021Download
vrs-48 Request for Member Information Change
03/2013Download
vrs-49 Change to Certification for Retirement
This form is no longer required. Employers make certification changes directly in myVRS Navigator.
Link
vrs-57 Authorization for Direct Deposit of Monthly Benefit
Retirees can update direct deposit information online through myVRS.
06/2021Download
vrs-58 Name and Address Declaration For Retirees
Just changing your address? Make the update using myVRS for quicker processing.
07/2021Download
vrs-61 Notification of Electronic Payment Information
09/2021Download
vrs-65d Termination Certification Form- Optional Retirement Plan for Higher Education
09/2021Download
vrs-65e Termination Certification Form - Optional Retirement Plan for Political Appointees
09/2020Download
vrs-67a Authorization of Administrative Contacts
05/2021Download
vrs-70 Request for Review of Membership Records
02/2011Download
vrs-71b Termination Certification Form - Optional Retirement Plan for School Superintendents
09/2020Download
vrs-75 Optional Retirement Plan Health Insurance Credit Employer Certification of Service
Completed by Optional Retirement Plan participants and by their employers, who certify employment.
12/2020Download
vrs-76 Certification of Employment for Health Insurance Credit Eligibility
Completed only by employers certifying general registrars, local officers, employees of these referenced positions and local social service employees.
07/2021Download
vrs-77 Certification of Hazardous Duty
04/2021Download
vrs-78 Authorization to Deduct Insurance Premiums
Completed only by employers for non-state participants.
07/2021Download
vrs-83 Certification of Eligibility to Participate in Virginia Supplemental Retirement Plan
01/2009Download
vrs-160 Certification of Eligibility for Critical Shortage Teachers and Administrators
07/2020Download
vrs-160c Certification of Eligibility for Retiree School Security Officers
07/2020Download
vrs-160d Certification of Eligibility for Critical Shortage Bus Drivers
07/2020Download
vrs-170 Authorization of Coverage Retention for the Long Term Care Plan (VSDP or VLDP)
01/2014Download
vrs-171 Protection Against Unintentional Lapse of Long Term Care (VSDP or VLDP)
01/2014Download
vrs-180 Employer Request for Forfeiture of Member Benefits
12/2015Download
vrs-900 Authorization to Discuss VRS Account Information
02/2011Download
vrs-901 VRS Durable Power of Attorney
01/2021Download

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