MEMBERS

Tier One/Tier Two/IAP Retirement Application - View a video on how to fill out the Tier One/Tier Two/IAP retirement application.

Tax Forms Packet  - Tax forms needed with retirement application.

W-4P - Form to withhold income tax from retirement benefit.

Direct Deposit – Required if you want to set up an automatic deposit of your benefit payments.

Federal Tax Information & Acknowledgement 

Verification of Age - List of acceptable documents for verification of age.

PERS: Rollover Eligible Distribution - Required only if you elect a lump-sum payment option and you wish to roll over the benefit. ​​

W-8BEN - Form to withhold income tax or claim treaty rights for non-resident, non-U.S. citizen persons.

W-9 - Required for any person with a foreign address.
 
Direct Deposit - Set up automatic deposit of your benefit payments.

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.

Tier One/Tier Two Pre-Retirement Guide

PERS Tier One/Tier Two Pre-Retirement Beneficiary Designation 

Information Change Request - Change your name, Social Security number, or address.

Date of Birth Change Request - Notice: Please use this new form to update your date of birth.

Estimate Request - Request an estimate.

PERS Additional Estimate Fee Agreement - Request an additional estimate.

PERS Lump-Sum Distribution Withholding Election - Form to elect lump-sum withdrawal withholdings.

Direct Transfer Rollover Acceptance - Roll over your benefit to a qualified employer or compensation plan.

Direct Deposit - Set up an 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 - Form is required for any additional data verification requests.

Special Power of Attorney - This form gives the person(s) you designate the power to make any and all decisions for PERS-related matters on your behalf. 

Authorization to Release Account Information​ - This form allows you to authorize a third party to obtain information regarding your PERS account or benefits.

Account Reconciliation Request - Form to capture and document concerns about the accuracy of your employment information for subsequent review and reconciliation by PERS staff.

Elective and Appointive Membership Election - Form for a person who  holds an elective or appointive office and elects to become an active member of PERS Tier One/Tier Two and IAP programs.

Workers' Compensation Certification - This form is to request PERS Tier One or Tier Two service credit under Oregon Revised Statutes Chapter 238.175 for periods of workers’ compensation or disability.

Dispute of Notice of Entitlement - This form allows a member to dispute the accuracy of the information used in the computation of their retirement benefit.

One Time-Variable Transfer: Active or Inactive Members - Use this form to transfer funds out of a variable account into a regular account.

Acknowledgment of Potential Consequences Relating to Working After Retirement

Important information

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