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COVID-19 Response: VRS is committed to serving you and continuing business operations during this challenging time. Latest Updates
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 | 08/2019 | Download |
| N/A | Approved Domestic Relations Orders - Defined Contribution Account(s) | 08/2019 | Download |
| 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. |
12/2018 | Download |
| T-20879 | State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants | 03/2020 | Download |
| VSDP-2 | College and University Opt-Out Form | 09/2011 | Download |
| VRS-2 | Designation of Beneficiary To designate more than 3 beneficiaries, a continuation form, the VRS-2A, is also required. |
02/2020 | Download |
| VRS-2A | Designation of Beneficiary - Continuation | 02/2020 | Download |
| VRS-3A | Name and Address Declaration For Deferred Members | 02/2011 | Download |
| VRS-3ORP | Request for Transfer of Funds to ORP | 07/2019 | Download |
| VRS-5 | Application for Service Retirement | 08/2019 | Download |
| VRS-6 | Application for Disability Retirement | 05/2020 | Download |
| VRS-6A | Explanation of Disability | 01/2019 | Download |
| VRS-6B | Physician's Report | 01/2019 | Download |
| VRS-6C | Request for Estimate of Disability Retirement Benefits | 02/2011 | Download |
| VRS-6D | Employer Information for Disability Application | 04/2019 | Download |
| VRS-6E | Certification of Alternate Employment for Disability Retiree for Political Subdivision Hazardous Duty Employees | 08/2012 | Download |
| VRS-7ORP | Notice of Return to Covered Employment Optional Retirement Plan Retiree | 11/2012 | Download |
| VRS-8 | Certification of Exception from General Early Retirement Provisions | 07/2013 | Download |
| VRS-11 | Employer Certification of Involuntary Separation Under the Workforce Transition Act | 02/2016 | Download |
| VRS-11A | Employer Certification of Basic Group Life Insurance Coverage Under Workforce Transition Act | 02/2011 | Download |
| VRS-11B | Employer Certification of Involuntary Separation Under the Transitional Benefits Program | 06/2015 | Download |
| VRS-11C | Employer Certification of VRS Basic Group Life Insurance Coverage Under the Transitional Benefits Program | 02/2011 | Download |
| VRS-15 | Request for Income Tax Withholding | 10/2018 | Download |
| VRS-26 | Application for Purchase of Prior Service Credit | 08/2017 | Download |
| 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. |
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| 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. |
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| VRS-45 | Request for Health Insurance Credit Retired participants who do not have premiums deducted from their VRS monthly benefit must complete this form. |
01/2020 | Download |
| VRS-48 | Request for Member Information Change | 03/2013 | Download |
| VRS-49 | Change to Certification for Retirement This form is no longer required. Employers make certification changes directly in myVRS Navigator. |
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| VRS-57 | Authorization for Direct Deposit of Monthly Benefit | 08/2019 | Download |
| VRS-58 | Name and Address Declaration For Retirees | 03/2013 | Download |
| VRS-61 | Notification of Electronic Payment Information | 03/2018 | Download |
| VRS-65D | Termination Certification Form- Optional Retirement Plan for Higher Education | 01/2017 | Download |
| VRS-65E | Termination Certification Form - Optional Retirement Plan for Political Appointees | 01/2017 | Download |
| VRS-67A | Authorization of Administrative Contacts | 05/2020 | Download |
| VRS-70 | Request for Review of Membership Records | 02/2011 | Download |
| VRS-71B | Termination Certification Form - Optional Retirement Plan for School Superintendents | 01/2017 | Download |
| 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. |
01/2020 | Download |
| 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. |
04/2019 | Download |
| VRS-77 | Certification of Hazardous Duty | 02/2011 | Download |
| VRS-78 | Authorization to Deduct Insurance Premiums Completed only by employers for non-state participants. |
04/2019 | Download |
| VRS-83 | Certification of Eligibility to Participate in Virginia Supplemental Retirement Plan | 01/2009 | Download |
| VRS-160 | Certification of Eligibility for Critical Shortage Teachers and Administrators | 07/2020 | Download |
| VRS-160C | Certification of Eligibility for Retiree School Security Officers | 07/2020 | Download |
| VRS-160D | Certification of Eligibility for Critical Shortage Bus Drivers | 07/2020 | Download |
| VRS-170 | Authorization of Coverage Retention for the Long Term Care Plan (VSDP or VLDP) | 01/2014 | Download |
| VRS-171 | Protection Against Unintentional Lapse of Long Term Care (VSDP or VLDP) | 01/2014 | Download |
| VRS-180 | Employer Request for Forfeiture of Member Benefits | 12/2015 | Download |
| VRS-900 | Authorization to Discuss VRS Account Information | 02/2011 | Download |
| VRS-901 | VRS Durable Power of Attorney | 10/2019 | Download |
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