You need the free Adobe® Reader® to view these forms.
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.
- PSRS Monthly Tax Withholding Authorization (pdf, 740 KB)
- Release of Information Authorization (pdf, 251 KB)
- PSRS Member Work Record (pdf, 964 KB)
- PSRS Member Information Change Form (pdf, 508 KB) You can update your mailing address, telephone number or email address online using Web Member Services.
- Direct Deposit Authorization for Monthly Benefit Payments (pdf, 627 KB) You can also update your monthly benefit direct deposit information online using Web Member Services.
To apply for service retirement, please print and complete the forms contained in the Service Retirement Application packet.
- PSRS Service Retirement Application Packet (pdf, 1709 KB) You can also apply for retirement online using Web Member Services.
- PSRS PLSO Distribution Form (pdf, 498 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 the
Not all purchase applications are available online. If you do not see the form you need, contact us.
- Reinstatement Application (pdf, 187 KB)
- PSRS Vo-Tech Application (pdf, 322 KB)
- PSRS Supplemental Service Purchase (pdf, 316 KB)
- PSRS Rollover Certification Instructions (pdf, 104 KB)
- PSRS Rollover Certification (pdf, 331 KB)
- PSRS Purchase of PEERS Service Application (pdf, 315 KB)
- PSRS Public School Purchase (pdf, 528 KB)
- PSRS Private School Employment Purchase (pdf, 959 KB)
- PSRS Military Service Purchase Application (pdf, 331 KB)
- PSRS Maternity Purchase Application (pdf, 894 KB)
- PSRS Post-Retirement Beneficiary Designation (Lump-Sum) (pdf, 1022 KB)
- PSRS Pre-Retirement Beneficiary Designation Form (pdf, 795 KB)
- PSRS Post-Retirement Beneficiary Designation (Term Certain Plan) (pdf, 813 KB)
- PSRS Disability Nomination of Beneficiary Form (pdf, 675 KB)
- $5,000 Death Benefit Beneficiary Designation (pdf, 648 KB)