Divorce forms

In compliance with the Americans with Disabilities Act (ADA), PERS will provide PDF documents on this page in an alternate format upon request. To request a document in an alternate format, call 888-320-7377 (toll free) or TTY 503-603-7766.

Before submitting any divorce-related forms, read our divorce information webpages:

Our overview page about divorce — Divorce.
Divorce information by your membership type — Divorce for Tier One/Tier Two members or Divorce for Oregon Public Service Retirement Plan (OPSRP) members.
Divorce information about the Individual Account Program — Divorce and the Individual Account Program (IAP).

Note that forms are designed to relate to your specific circumstances and are available for nonretired and retired members.

Because divorce often involves one or both parties moving, a common form you may need is our Information Change Request. Complete and return the request form to PERS to update your address on file.

Important: Before divorce processing can be completed, PERS must receive the Alternate Payee Information Verification form from the alternate payee (AP).

Divorce forms to include with court orders

The following three sections list forms that are used to create an award or beneficiary restriction or to document that there is no award in your court order. Members who are getting a legal separation also may want to include the spousal consent waiver form. The appropriate forms must be completed, labeled, and referenced as exhibits in your court order. If you have any questions about which forms to include, contact PERS for assistance.

Beneficiary designations

The following three sections list forms that are used to name or change a beneficiary after a divorce.

If you need to name additional beneficiaries, you will need to submit a completed Supplemental Insert to Name Additional Beneficiaries form with your beneficiary designation.

Tier One/Tier Two

Members

Tier One/Tier Two Preretirement Beneficiary Designation (459-094)

This is a standard member designation form. Nonretired divorced members can use this form if they have no court ordered beneficiary restrictions.

Divorce: Tier One/Tier Two Preretirement Designation to Name Secondary Beneficiaries (459-765)

This form is for divorced members who must name their alternate payee (AP), former spouse, or former registered domestic partner (RDP) for a portion of their preretirement death benefits and who are also allowed to name secondary beneficiaries for the portion of their Tier One/Tier Two preretirement death benefits not designated to their AP, former spouse, or former RDP.

Tier One/Tier Two Post-retirement Beneficiary Designation (459-672)

This is a standard member designation form. Retired divorced members who have selected a nonsurvivorship retirement option can use this form if they have no court ordered beneficiary restrictions.

Divorced: Post-retirement Designation to Name Secondary Beneficiaries (459-740)

This form is strictly for retired members who have an administrable court order on file with PERS that permits the designation of secondary beneficiaries for the portion of their Tier One/Tier Two or OPSRP death pension benefits not designated to an AP, former spouse, or former RDP as specified in the court order.

Divorce: Post-retirement Survivorship Beneficiary Change (459-756)

This form is strictly for retired members who have an administrable court order on file with PERS that provides an award to an AP and allows a beneficiary change for a survivorship option.

Alternate payees

Alternate Payee Tier One/Tier Two Preretirement Beneficiary Designation (459-638)

This form is used in one of two circumstances:
- By an AP or former RDP who was awarded a portion of a Tier One/Tier Two member’s account.
  OR
- Before retirement by APs and former RDPs who were:
  - Awarded a portion of a Tier One/Tier Two member’s benefit by a Reduction, Deduction, or Separate benefit award.
    AND
  - Allowed to name a beneficiary to receive divorce benefits if they were to die prior to retirement.

Alternate Payee Post-retirement Beneficiary Designation for Reduction or Deduction Awards (459-767)

This form is for an AP or former RDP who is receiving Reduction or Deduction benefit payments from a retired member, and whose court order directs their divorce award to continue to be paid after the AP’s or former RDP’s death.

Alternate Payee Tier One/Tier Two Post-retirement Beneficiary Designation (459-768)

This form is for an AP who was awarded a Separate Account from a member’s Tier One/Tier Two account so that they can name a post-retirement beneficiary for beneficiary benefits from their Tier One/Tier Two AP account, if any.

OPSRP

Members

OPSRP members do not have preretirement beneficiary designation options. A nonretired OPSRP member’s surviving spouse is automatically their beneficiary. If directed by court order, an alternate payee (AP) also may be an OPSRP member’s preretirement beneficiary. No designation forms are required.

OPSRP members cannot change their post-retirement beneficiary unless a court order allows it; otherwise, the beneficiary named at retirement cannot be changed.

Divorced: Post-retirement Designation to name Secondary Beneficiaries (459-740)

This form is strictly for retired members who have an administrable court order on file with PERS that permits the designation of secondary beneficiaries for the portion of their Tier One/Tier Two or OPSRP death pension benefits not designated to an AP, former spouse, or former registered domestic partner (RDP) as specified in the court order.

Divorce: Post-retirement Survivorship Beneficiary Change (459-756)

This form is strictly for retired members who have an administrable court order on file with PERS that provides an award to an AP and allows a beneficiary change for a survivorship option.

Alternate payees

APs of OPSRP members do not have preretirement beneficiary designation options. If a court order directs a divorce award to be paid to an OPSRP AP’s beneficiary in the event the AP dies prior to retirement, the AP’s surviving spouse is automatically the AP’s beneficiary. No designation forms are required. If the AP dies before retirement without a surviving spouse, they have no beneficiary.

Alternate Payee Post-retirement Beneficiary Designation for Reduction or Deduction Awards (459-767)

This form is for an AP or former RDP who is receiving Reduction or Deduction benefit payments from a retired member and whose court order directs their divorce award to continue to be paid after the AP’s or former RDP’s death.

IAP

Members

IAP Preretirement Beneficiary Designation (459-469)

This is a standard member designation form. Nonretired divorced members should use this form to name preretirement IAP beneficiaries.

IAP Post-retirement Beneficiary Designation (459-476)

This is a standard member designation form. Retired divorced members, who are receiving their IAP benefit in installments, should use this form to name post-retirement IAP beneficiaries.

Alternate payees

Alternate Payee IAP Preretirement Beneficiary Designation (459-758)

This form is for an AP or former RDP, who was awarded a portion of a member’s IAP account, to name a preretirement beneficiary for their IAP.

Alternate Payee IAP Post-retirement Beneficiary Designation (459-761)

This form is for an AP who was awarded a portion of a member’s IAP account to name a post-retirement beneficiary for their IAP if they are receiving their IAP benefit in installments.

IAP Revocation of Spousal Consent of Beneficiary Designation (459-433)

This form is for a spouse to revoke a previous consent to an IAP beneficiary other than themselves. If an AP’s spouse has consented to the AP selecting an IAP beneficiary other than themselves, the AP’s spouse has the right to revoke their consent up to the time of the AP’s death.

Getting an estimate

If your account has been impacted by divorce, use one of these forms to request a benefit estimate.

Tier One/Tier Two

Members

Tier One/Tier Two Estimate Request for Member with a Divorce-Related Account (459-599)

A nonretired member who had a portion of their Tier One/Tier Two account or benefit awarded to an alternate payee (AP) or former registered domestic partner (RDP) should use this form to request a benefit estimate. Divorced members should not use Online Member Services (OMS) to generate a benefit estimate as OMS cannot properly account for the impact the divorce has on a member’s benefit.

Divorce: Survivorship Beneficiary Change Estimate Request (459-766)

This form is strictly for retired members who have an administrable court order on file with PERS that provides an award to an AP and allows a beneficiary change for a survivorship option. If the member’s new beneficiary is younger than the current beneficiary, it can significantly reduce the member’s benefit. It is advisable for members to request a benefit estimate using this form prior to requesting a survivorship beneficiary change. A survivorship beneficiary change is a one-time irreversible change.

Alternate payees

Tier One/Tier Two Alternate Payee Estimate Request (459-600)

This form is for an AP who was awarded a Separate Account from a member’s Tier One/Tier Two account or a Separate Benefit from a member’s Tier One/Tier Two benefit to request a benefit estimate.

Note: APs or former RDPs who were awarded Reduction or Deduction benefits cannot request estimates.

OPSRP

Members

Oregon Public Service Retirement Plan (OPSRP) Estimate Request (459-533)

This is a standard OPSRP member estimate request form. A nonretired member, who had a portion of their OPSRP benefit awarded to an AP or former RDP, should use this form to request a benefit estimate. Divorced members should not use Online Member Services (OMS) to generate a benefit estimate as OMS cannot properly account for the impact the divorce has on a member’s benefit.

Divorce: Survivorship Beneficiary Change Estimate Request (459-766)

This form is strictly for retired members who have an administrable court order on file with PERS that provides an award to an AP and allows a beneficiary change for a survivorship option. If the member’s new beneficiary is younger than the current beneficiary, it can significantly reduce the member’s benefit. It is advisable for members to request a benefit estimate using this form prior to requesting a survivorship beneficiary change. A survivorship beneficiary change is a one-time irreversible change.

Alternate payees

Oregon Public Service Retirement Plan (OPSRP) Estimate Request (459-533)

This is a standard OPSRP member estimate request form. Currently, we do not have a form tailored for OSPRP APs to request an estimate. APs who have received a Separate Benefit award of an OPSRP member’s benefit should use this form to request an estimate of their separate benefit.

Note: APs or former RDPs who were awarded Reduction or Deduction benefits cannot request estimates.

IAP

Members and alternate payees can use the IAP Balance and Installment Calculator to estimate IAP benefits.

This calculator generates estimates assuming that all members have a 6% salary contribution to their IAP accounts. The calculator does not factor in Senate Bill 1049 (2019) contribution changes, such as the redirect to Employee Pension Stability Account (EPSA); therefore, the tool may overestimate IAP monthly retirement benefits.

Drawing a benefit from a divorce account

For members to apply for benefits, a divorce-specific application is not needed. APs should use the forms below to apply for benefits.

Tier One/Tier Two

Withdrawal

Alternate Payee (AP) Account Withdrawal Application Packet (459-588)

This packet includes an application and forms that can be used by an AP to withdraw their Tier One/Tier Two Separate Account award, and/or their IAP Separate Account award.

Note: APs or former registered domestic partners (RDP) who were awarded Reduction, Deduction, or Separate Benefit awards from a member’s Tier One/Tier Two benefit cannot withdraw their awarded Tier One/Tier Two benefit.

Retirement

Alternate Payee Tier One/Tier Two Benefit Application (459-007)

This application can be used by an AP to retire their Tier One/Tier Two Separate Account award or their Tier One/Tier Two Separate Benefit award.
Additional forms that may be needed at retirement are:
- Domestic Authorization Agreement for Automatic Deposits (459-001)
- W-4P form for federal and state tax withholding on periodic payments
- W-4R Tier One/Tier Two Lump Sum Withholding (459-524)
- Tier One/Tier Two Program Direct Transfer Rollover Acceptance (459-388)

Note: APs or former RDPs who were awarded Reduction or Deduction awards from a member’s Tier One/Tier Two benefit do not submit a retirement application. The benefit will be initiated when the member retires.

OPSRP

Withdrawal

Alternate payees (AP) or former registered domestic partners (RDP) who were awarded Reduction, Deduction, or Separate Benefit awards from a member’s OPSRP benefit cannot withdraw their awarded OPSRP benefit.

Retirement

Alternate Payee OPSRP Pension Program Separate Benefit Application (459-635)

This application can be used by an AP to retire their OPSRP Separate Benefit award.
If a monthly benefit is due at retirement, they also should submit:
- W-4P form for federal and state tax withholding on periodic payments

Note: APs or former RDPs who were awarded Reduction or Deduction awards from a member’s OPSRP benefit do not submit a retirement application. The benefit will be initiated when the member retires.

IAP

Withdrawal

Alternate Payee (AP) Account Withdrawal Application Packet (459-588)

This application packet can be used by an AP to withdraw their IAP Separate Account award.

Retirement

Individual Account Program Retirement Application (459-664)

This application can be used by an AP to retire their IAP Separate Account award.
Additional forms that may be needed at retirement are:
- Domestic Authorization Agreement for Automatic Deposits (459-001)
- W-4P form for federal and state tax withholding on periodic payments
- W-4R IAP Lump-sum Withholding (459-549)
- IAP Direct Transfer Rollover Acceptance (459-388)