Employer forms

261 Employer Data Agreement (not available online)

• Prospective PERS employers receive this form from the Employer Service Center when they initiate the process to join PERS, as explained on the About Joining PERS webpage.
• Instructions for filling out the form.

425 Web Administrator Agreement

• New web administrators must submit this form to receive an EDX account from PERS.
• Instructions for filling out the form.

475 ACH Agreement and 474 ACH Debit Authorization

• Employers must submit the ACH Agreement form to PERS so that they can pay their invoice through Automated Clearing House. Employers can choose to pay by debit (automatic payment) or credit (employer-initiated payment).
• Employers who choose to pay by debit must also submit form 474 ACH Debit Authorization. Employers can also use form 474 to change their bank or account information.

624 Data Verification -- Employer Request for an Extension

• This form enables employers to request an extension to the 30-day deadline for completing a data verification of an employee’s work history.

775 Employer Change of Address

• Employers submit this form to PERS to report a change of address for their organization (either mailing address or physical address or both).

Police and Fire forms

093 Police Officer and Firefighter (P&F) Unit Purchase form #459-093 (monthly deductions)

073 Police Officer and Firefighter Unit Purchase Election at Retirement form #459-073 (lump sum payment)

• These forms allow Tier One/Tier Two members in the Police and Fire job classification to purchase units. Learn about units on the Police and Fire Unit Benefits webpage.

Other forms

Certification forms

Member forms

General instructions

Instructions for filling out and submitting a form.