Forms

General Forms

• Member Information Change
• Release of Information Authorization

Service Retirement

• Service Retirement Application Packet
• Partial Lump Sum Option Distribution Election
  • IRS Form W-4R with FAQs (tax withholding for PLSO election)
  • Your Rollover Options

Service Purchases

• Application to Purchase Active Duty Military Service
• Application to Purchase PSRS-Covered Employment
• Application to Purchase Private School Employment
• Application to Purchase Public School Service (at schools not covered by PEERS)
• Application to Purchase Social Security-Covered Employment
• A Detailed Earnings Statement from Social Security Administration (https://www.ssa.gov/forms/ssa-7050.pdf) is required with your purchase application for Social Security-covered service.
• Application to Purchase Unpaid Maternity/Paternity Leave
• Application to Purchase Supplemental Service
• Application to Purchase Vo-Tech Service

Pre-Tax Rollover /Transfer Certification Forms

• PEERS Rollover or Transfer Certification Traditional IRA
  Use this form if you are rolling funds from a Tradiitonal IRA or Individual Retirement Annuity to purchase service.
• PEERS Rollover or Transfer Certification Other Qualified Plans
  Use this form if you are rolling funds from any other type of qualified plan to purchase service.

Disability Retirement

If you wish to apply for disability benefits, please contact us.

• Authorization for Release of Medical Records
• PEERS Attending Physician Statement
• Disability Retirement Application Packet

Beneficiary Designations

• Pre-Retirement Beneficiary Designation