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Retired member forms

All PERS forms must be printed and signed. You can submit completed forms by fax, by mail, or by dropping them off at PERS offices in Tigard or Salem.

For forms assistance, call PERS Member Services at 888-320-7377 (toll-free) or TTY 503-603-7766. PERS provides, upon request, reasonable accommodations, including large print versions of forms and support reviewing and completing your forms over the phone or in person. You can also request to have forms mailed to you or pick up blank forms at a PERS office.

PERS Residency Status Certification Form to certify that you are or are not an Oregon state resident.

Information Change Request Form to change your name, email, phone number, Social Security number, or address.​

Direct deposit Set up automatic deposit of your benefit payments.

Verification of Age List of acceptable documents for verification of age, which is required before payment of distribution.

Police and Fire Retiree Direct Insurance Premium Payment Election Form to withhold a specified portion of your retirement benefit and use it to make direct payment of insurance premiums on your behalf.

Special Power of Attorney for PERS 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.

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

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

W-9 — Required for any person with a foreign address.

W-4R IAP Rollover-eligible Distribution

Federal Tax Information and Acknowledgement

Federal tax withholding calculator — The Internal Revenue Service offers this tool for estimating withholdings.

Oregon tax withholding calculator — Oregon Department of Revenue offers this personal income tax calculator.

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Post-retirement Beneficiary Designation For members who retired under the refund annuity or 15-year certain options or who are receiving lump-sum installments. This election does not impact your Individual Account Program (IAP) beneficiary designation. 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.

Dispute Notice of Entitlement Tier One/Tier Two Form to dispute the accuracy of information used in the computation of Tier One/Tier Two retirement benefits.

Acknowledgment of Potential Consequences Relating to Working After Retirement

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Dispute Notice of Entitlement OPSRP Form to dispute the accuracy of information used in the computation of OPSRP retirement benefits.

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Supplemental Insert to Name Additional Beneficiaries

IAP Retirement Application For members who have retired from Tier One/Tier Two or OPSRP but not the IAP.

IAP: Beneficiary Nonspouse Rollover-eligible Distribution

Retirement Designation of Beneficiary Packet For IAP retirees who elected an IAP installment plan upon retirement

Supplemental Insert to Name Additional Beneficiaries ​ Submit with your pre- or post-retirement beneficiary designation forms If you need to name additional beneficiaries.

IAP Dispute of Notice of Distribution Form to dispute the accuracy of information used in the computation of the IAP distribution.

IAP Direct Transfer Rollover Acceptance

IAP Rollover-eligible Distribution Note: View this webpage if you are already receiving IAP installment payments and want to confirm which forms to turn in, if you are cashing out or rolling over the remainder of your IAP balance.

Troubleshooting

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