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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.

employer Service Retirement Forms
Form #DescriptionLast UpdatedLink
T-20879 State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants 03/2019 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-5 Application for Service Retirement 08/2019 Download
VRS-8 Certification of Exception from General Early Retirement Provisions 07/2013 Download
VRS-15 Request for Income Tax Withholding 10/2018 Download
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-49 Change to Certification for Retirement
This form is no longer required. Employers make certification changes directly in myVRS Navigator.
VRS-57 Authorization for Direct Deposit of Monthly Benefit 08/2019 Download
VRS-77 Certification of Hazardous Duty 02/2011 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-900 Authorization to Discuss VRS Account Information 02/2011 Download
VRS-901 VRS Durable Power of Attorney 10/2019 Download

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