- |
Approved Domestic Relations Orders - Defined Benefit Plan
|
08-2019 |
|
- |
Approved Domestic Relations Orders - Defined Contribution Account(s)
|
08-2019 |
|
ALL |
Hybrid Forms for Members
|
N/A |
|
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.
|
N/A |
|
ALL |
Hybrid Forms for Employers
|
N/A |
|
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.
|
10-2020 |
|
A10601 |
State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants
|
03-2022 |
|
VSDP-2 |
College and University Opt-Out Form
|
09-2011 |
|
VRS-2 |
Designation of Beneficiary
VRS members and retirees now update beneficiaries online through their secure myVRS account.
|
01-2022 |
|
VRS-2A |
Designation of Beneficiary - Continuation
VRS members and retirees now update beneficiaries online through their secure myVRS account.
|
01-2022 |
|
VRS-3A |
Name and Address Declaration For Deferred Members
|
02-2011 |
|
VRS-3ORP |
Request for Transfer of Funds to ORP
|
07-2019 |
|
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.
|
09-2021 |
|
VRS-6 |
Application for Disability Retirement
|
04-2022 |
|
VRS-6A |
Explanation of Disability
|
01-2019 |
|
VRS-6B |
Physician's Report
|
01-2019 |
|
VRS-6C |
Request for Estimate of Disability Retirement Benefits
|
02-2011 |
|
VRS-6D |
Employer Information for Disability Application
|
10-2020 |
|
VRS-6E |
Certification of Alternate Employment for Disability Retiree for Political Subdivision Hazardous Duty Employees
|
08-2012 |
|
VRS-7ORP |
Notice of Return to Covered Employment Optional Retirement Plan Retiree
|
11-2012 |
|
VRS-8 |
Certification of Exception from General Early Retirement Provisions
|
04-2022 |
|
VRS-11 |
Employer Certification of Involuntary Separation Under the Workforce Transition Act
|
02-2016 |
|
VRS-11A |
Employer Certification of Basic Group Life Insurance Coverage Under Workforce Transition Act
|
02-2011 |
|
VRS-11B |
Employer Certification of Involuntary Separation Under the Transitional Benefits Program
|
06-2015 |
|
VRS-11C |
Employer Certification of VRS Basic Group Life Insurance Coverage Under the Transitional Benefits Program
|
02-2011 |
|
VRS-15 |
Request for Income Tax Withholding
|
08-2020 |
|
VRS-26 |
Application for Purchase of Prior Service Credit
|
03-2022 |
|
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.
|
N/A |
|
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.
|
N/A |
|
VRS-26H |
Application to Purchase Prior Service Credit (For Superintendents of Schools)
|
02-2011 |
|
VRS-45 |
Request for Health Insurance Credit
Retirees can update health insurance policy information online through myVRS.
|
02-2023 |
|
VRS-48 |
Request for Member Information Change
|
03-2013 |
|
VRS-49 |
Change to Certification for Retirement
This form is no longer required. Employers make certification changes directly in myVRS Navigator.
|
N/A |
|
VRS-57 |
Authorization for Direct Deposit of Monthly Benefit
Retirees can update direct deposit information online through myVRS.
|
06-2021 |
|
VRS-58 |
Name and Address Declaration
Just changing your address? Make the update using myVRS for quicker processing.
|
07-2021 |
|
VRS-61 |
Notification of Electronic Payment Information
|
09-2021 |
|
VRS-65D |
Termination Certification Form- Optional Retirement Plan for Higher Education
|
09-2021 |
|
VRS-65E |
Termination Certification Form - Optional Retirement Plan for Political Appointees
|
01-2022 |
|
VRS-67A |
Authorization of Administrative Contacts
|
04-2022 |
|
VRS-70 |
Request for Review of Membership Records
|
02-2011 |
|
VRS-71B |
Termination Certification Form - Optional Retirement Plan for School Superintendents
|
09-2020 |
|
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.
|
02-2023 |
|
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.
|
07-2021 |
|
VRS-77 |
Certification of Hazardous Duty
|
04-2021 |
|
VRS-78 |
Authorization to Deduct Insurance Premiums
Completed only by employers for non-state participants.
|
07-2021 |
|
VRS-160 |
Certification of Eligibility for Critical Shortage Teachers and Administrators
|
07-2020 |
|
VRS-160C |
Certification of Eligibility for Retiree School Security Officers
|
07-2020 |
|
VRS-160D |
Certification of Eligibility for Critical Shortage Bus Drivers
|
07-2020 |
|
VRS-170 |
Authorization of Coverage Retention for the Long Term Care Plan (VSDP or VLDP)
|
01-2022 |
|
VRS-171 |
Protection Against Unintentional Lapse of Long Term Care (VSDP or VLDP)
|
01-2022 |
|
VRS-180 |
Employer Request for Forfeiture of Member Benefits
|
12-2015 |
|
VRS-900 |
Authorization to Discuss VRS Account Information
|
02-2011 |
|
VRS-901 |
VRS Durable Power of Attorney
|
01-2021 |
|