Forms
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Please keep a copy of all completed forms for your records.
If you have problems viewing any of these forms or would like a copy mailed to you, contact us.
Completed forms can be submitted online using the new Document Upload functionality available in Web Member Services. You can also mail or fax them to our office.
Basic Forms
- PEERS Member Information Change Form (pdf, 508 KB) Use this form to request a change of your personal information, such as name or address. You can also update your mailing address, telephone number or email address online using Web Member Services.
- PEERS Member Work Record form (pdf, 473 KB)
- PEERS Monthly Benefit Direct Deposit Authorization Form (pdf, 419 KB)
- PEERS Monthly Benefit Tax Withholding Authorization (pdf, 456 KB) You can also update your monthly benefit tax withholding information online using Web Member Services.
- PEERS Release of Information Authorization (pdf, 251 KB)
Service Retirement Forms
- PEERS Service Retirement Application Packet (pdf, 1135 KB) You can also apply for retirement online using Web Member Services.
- PEERS PLSO Distribution Form (pdf, 490 KB) If you are eligible and choose the Partial Lump Sum Option (PLSO) at retirement, you must also print and complete this form.
Reinstatement and Service Purchases
If you plan to pay for a reinstatement or purchase with money rolled over from a qualified account, please print and complete this form:
Purchase Applications
Not all purchase applications are available online. If you do not see the form you need, contact us.
- PEERS Social Security Covered Employment Purchase Application A Detailed Earnings Statement from the Social Security Administration is required with your purchase application for Social Security-covered service.
- PEERS Maternity Purchase Application (pdf, 579 KB)
- PEERS Military Service Purchase Application (pdf, 329 KB)
- PEERS Private School Employment Service Purchase (pdf, 954 KB)
- PEERS Public School Service Purchase Application (pdf, 527 KB)
- PEERS Purchase of PSRS Service Application (pdf, 328 KB)
- PEERS Supplemental Service Purchase Application (pdf, 319 KB)
- PEERS Vo-Tech Service Purchase Application (pdf, 504 KB)
Beneficiary Designations
- PEERS Pre-Retirement Beneficiary Designation Form (pdf, 677 KB)
- PEERS Post-Retirement Beneficiary Designation Form (Term-Certain Option) (pdf, 814 KB)
- PEERS Post-Retirement Beneficiary Designation (Lump-Sum) (pdf, 871 KB)
- PEERS Disability Retirement Nomination of Beneficiary form (pdf, 674 KB)
Disability Retirement
- Authorization for Release of Medical Records (pdf, 493 KB)
- PEERS Disability Retirement Application form (pdf, 610 KB)
- PEERS Disability Retirement Application Packet (pdf, 872 KB)