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PSRS Members

Active Member and Retiree Forms

You need the free Adobe® Reader® to view these forms. Please note that you must click the “clear” button on the form in order to delete the information you entered. This is especially important if you use a shared or public computer to fill out your form.

Please keep a copy of all completed forms for your records.

General Forms
Adobe Acrobat Address Change Form
Adobe Acrobat Name Change Form
Adobe Acrobat Release of Information Authorization
   
Forms for Active Members
Adobe Acrobat Pre-Retirement Beneficiary Designation*
For helpful information about designating beneficiaries, view the Protecting Those You Care About brochure.
*This form establishes your beneficiary designation with PSRS prior to your retirement.
 
  Credit Purchase Applications
  If you plan to pay for your purchase with money rolled over from a qualified account, please print and complete the Rollover/Transfer Certification form and Information Sheet.
Adobe Acrobat Application to Reinstate Credit
Adobe Acrobat Application to Purchase PEERS-covered Employment
Adobe Acrobat Application to Purchase Supplemental Credit
Adobe Acrobat Application to Purchase Social Security-Covered Employment
A Detailed Earnings Statement from Social Security Administration is required.
Adobe Acrobat Application to Purchase Public School Employment
Adobe Acrobat Application to Purchase Private School Employment
Adobe Acrobat Application to Purchase Unpaid Maternity/Paternity Leave
Adobe Acrobat Application to Purchase Active Duty Military Service
Adobe Acrobat Application to Purchase Vo-Tech Work Experience
   
  Getting Ready to Retire Forms
Adobe Acrobat Service Retirement Application
To apply for service retirement, please also print and complete these forms: If you are eligible and choose to take the Partial Lump Sum Option (PLSO) at retirement, please print and complete the PLSO Distribution Election form and return it with your Service Retirement Application.
 
Adobe Acrobat Disability Retirement Application
To apply for disability retirement, please also print and complete these forms:
   
Forms for Retirees
Adobe Acrobat Tax Withholding Authorization Form
Adobe Acrobat Direct Deposit Authorization Form
Adobe Acrobat Working After Retirement Record Keeping Form
   
  Beneficiary Designation Forms
Adobe Acrobat $5,000 Death Benefit Beneficiary Designation Form
Adobe Acrobat Disability Retirement Beneficiary Designation
Adobe Acrobat Post-Retirement Beneficiary Designation for Lump-Sum Payment of Account Balance
Use this form only if you chose the Single Life or one of the Joint-and-Survivor benefit plans and the remaining balance of your account is payable. To change your $5,000 Death Benefit beneficiary, use the $5,000 Death Benefit Beneficiary Designation form, above.

Adobe Acrobat Post-Retirement Beneficiary Designation for the Term-Certain Plans
Use this form if you chose a Term-Certain benefit plan at retirement.
   
Forms for Survivor Benefit Recipients
Adobe Acrobat Fall Semester Certification of School Official Form
Adobe Acrobat Spring Semester Certification of School Official Form
Adobe Acrobat Summer Certification of Parent/Guardian Form