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||Download|
|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.
|VRS-2A||Designation of Beneficiary - Continuation||12/2014|
|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.
|VRS-57||Authorization for Direct Deposit of Monthly Benefit||01/2019|
|VRS-58||Name and Address Declaration For Retirees||03/2013|
|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.
|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|