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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 |
08/2019 | 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. |
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-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. |
Link | |
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 |
09/2020 | Download |
vrs-65e | Termination Certification Form - Optional Retirement Plan for Political Appointees |
09/2020 | 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 |
09/2020 | 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 |