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|
|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.
|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.
|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|