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Tier One/Tier Two and Individual Account Program (IAP) Retirement Forms and Information
Steps to retire (only steps 5 and 7 are required, but we recommend you consider the others).   Required forms
1. Am I eligible to retire? If you are a school or academic employee, please read this. Tier One/Tier Two Retirement Application

IAP Retirement Application

As of January 1, 2011, you must retire from Tier One/Tier Two and the Individual Account Program (IAP) at the same time. The retirement applications for both are linked on the left.
2. Get a benefit estimate. You can use Online Member Services or request a written benefit estimate. PERS processes most benefit estimates in order of retirement date. Benefit estimates use actuarial factors effective January 1, 2016.
What will my written benefit estimate look like?
View terms used in a written benefit estimate.
Tax Forms Packet Tax forms needed with retirement application.
3. Register for a retirement education presentation. W-4P 2017 Form to withhold income tax from retirement benefit.
4. Read the Pre-Retirement Guide for step-by-step information about retiring as a Tier One/Tier Two member. The Guide will help you complete your Service Retirement Application. Federal Tax Information & Acknowledgement   
5. Complete the Tier One/Tier Two and Individual Account Program (IAP) Service Retirement Application. You will receive your first benefit payment within 92 days of your effective retirement date. View a video on how to fill out a Tier One/Tier Two retirement application. Verification of Age List of acceptable documents for verification of age.
6. Attend a Retirement Application Assistance Session if you are retiring within 90 days. These forms may be required 
7. Notify your employer that you are retiring. Your employer must send a Notice of Separation to PERS so we can process your retirement. PERS: Rollover Eligible Distribution Required only if you elect a lump-sum payment option and you wish to rollover the benefit.
8. PERS offers health and dental insurance to PERS retirees and eligible dependents. Click here for more information. W-8BEN Form to withhold income tax or claim treaty rights for non-resident, non-U.S. citizen persons.
Other information W-9 Required for any person with a foreign address.
Optional forms​ ​
If you have questions or need to look up a specific Tier One/Tier Two subject, please visit A-Z: Tier One/Tier Two Quick Answer.

Account withdrawal (For those who are not eligible to retire and not working for a PERS-covered employer.) 

PERS Health Insurance Program information

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Chrome users click here for important information.

911 operators can retire after 25 years of service. To ensure you meet this requirement, complete this form, and submit it to PERS.

Trustee-to-Trustee Transfer to PERS for Purchases  Form to purchase service time using pre-tax dollars from a 457 governmental-deferred compensation plan like the Oregon Savings Growth Plan (OSGP) or a 403(b) tax-sheltered annuity.
PERS Lump-Sum Distribution Withholding Election To elect lump-sum withdrawal withholdings.
Direct Transfer Rollover Acceptance Roll over benefit to qualified employer or compensation plan.
Direct Deposit  Set up automatic deposit of your benefit payments.
Data Verification Request  Active or inactive members who are within two years of their earliest retirement age can request a verification of certain data.
Data Verification Fee Agreement This form is required for any additional data verification requests.
Account Reconciliation Request This form is used to capture and document concerns about the accuracy of your employment information for subsequent review and reconciliation by PERS staff.
​Workers' Compensation Certification ​Use this form to request PERS Tier One or Tier Two service credit under Oregon Revised Statutes Chapter 238.175 for periods of workers’ compensation or disability.
Acknowlegment of Potential Consequences Relating to Working After Retirement


If you are a police officer, firefighter, 911 Telecommunicator, educator, or judge member, you may need to complete the forms listed below.
Police, Firefighters, & 911 Telecommunicators
Education Members
Judge Members

P & F Unit Packet
In addition to your Service Retirement Application and supplemental forms, you must complete and return each of the forms within the P & F packet above.

P & F Unit Purchase Election at Retirement

Rollover Eligible Distribution
Certification of Non-Participating Oregon PERS Employer for Police or Firefighter

Certification of Out-of-State Police Service

Certification of 911 Operator Service

 Link to P & F Unit Q and A  

Certification of Out-of-State Teaching Service 

Judge Members Retirement Application 

Judges Member Variable Form 

PERS provides all online forms and publications in .pdf format. To view them, you must have the most recent version of Adobe Reader®. Click here to download Adobe Reader®.