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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.
12/2018Download
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
To designate more than 3 beneficiaries, a continuation form, the VRS-2A, is also required.
02/2020Download
vrs-2a Designation of Beneficiary - Continuation
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
08/2019Download
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
04/2019Download
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
10/2018Download
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-45 Request for Health Insurance Credit
Retired participants who do not have premiums deducted from their VRS monthly benefit must complete this form.
01/2020Download
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
08/2019Download
vrs-58 Name and Address Declaration For Retirees
03/2013Download
vrs-61 Notification of Electronic Payment Information
03/2018Download
vrs-65d Termination Certification Form- Optional Retirement Plan for Higher Education
09/2020Download
vrs-65e Termination Certification Form - Optional Retirement Plan for Political Appointees
09/2020Download
vrs-67a Authorization of Administrative Contacts
05/2020Download
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.
01/2020Download
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.
04/2019Download
vrs-77 Certification of Hazardous Duty
02/2011Download
vrs-78 Authorization to Deduct Insurance Premiums
Completed only by employers for non-state participants.
04/2019Download
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
10/2019Download

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