VRS Logo Monday, September 16, 2019
Print Page

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.

retiree Forms
Form #DescriptionLast UpdatedDownload
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.
T-20879 State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants 03/2019
VRS-2 Designation of Beneficiary
To designate more than 3 beneficiaries, a continuation form, the VRS-2A, is also required.
09/2019
VRS-2A Designation of Beneficiary - Continuation 09/2019
VRS-7ORP Notice of Return to Covered Employment Optional Retirement Plan Retiree 11/2012
VRS-15 Request for Income Tax Withholding 10/2018
VRS-45 Request for Health Insurance Credit
Retired participants who do not have premiums deducted from their VRS monthly benefit must complete this form.
04/2019
VRS-57 Authorization for Direct Deposit of Monthly Benefit 08/2019
VRS-58 Name and Address Declaration For Retirees 03/2013
VRS-160 Certification of Eligibility for Critical Shortage Teachers and Administrators 04/2010
VRS-900 Authorization to Discuss VRS Account Information 02/2011
VRS-901 VRS Durable Power of Attorney 07/2016

Additional Resources

Top