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The following packet contains required forms you need to successfully apply for retirement. Review and complete all forms in this packet. If you are attending a
retirement application assistance session, bring all of these forms to your session.
OPSRP-IAP Retirement Application - As of January 1, 2011, you must retire from the OPSRP Pension Program and the Individual Account Program (IAP) at the same time.
If you wish to apply for retirement and need forms, click on “Retirement
Application Packet" above and complete the forms in the packet. Submitting an
incomplete retirement application may delay your retirement process.
The forms listed individually here are provided for other times you may need these forms,
such as to update your tax withholding (W-4P) or your banking information (direct
W-4P Federal tax withholding form.
Direct Deposit – Required if you want to set up an automatic deposit of your benefit
Federal Tax Information and Acknowledgement
Verification of Age - List of acceptable documents for verification of age, which is required before
payment of benefits.
IAP Direct Transfer Rollover Acceptance - Required only if you want to roll over your IAP balance to a qualified employer or
deferred compensation plan.
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.
- Set up automatic deposit of your benefit payments.
Information Change Request - Change your name, SS number, or address.
Date of Birth Change Request
- Notice: Please use this new form to update your date of birth.
Data Verification Additional Account Information - This form allows you to provide additional information for your Data Verification
Data Verification Request - Tier One/Tier Two and OPSRP Pension Program active or inactive members who are within
two years of their earliest retirement age can request a verification of certain data.
- Form to request an OPSRP benefit estimate.
Estimate Request Fee Agreement - Form to requesting more than two estimates in a year.
OPSRP Elective and Appointive Membership Election - Form for a person who holds an elective or appointive office and wants to elect not
to become an OPSRP Pension Program member.
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.
Account withdrawal - For those who are not eligible to retire and not working for a PERS-covered employer.
OPSRP 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.
OPSRP Rollover-Eligible Distribution
- Used only if you are eligible for a one-time, lump-sum OPSRP pension payment because your
benefit is calculated as less than $200 a month.
W-4R OPSRP Lump Sum Withholding - Form to elect lump-sum withholdings.
OPSRP Direct Transfer Rollover Acceptance - Roll over your benefit to a qualified employer or compensation plan
If you are experiencing problems opening a form, use the appropriate link below.
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.
PERS accepts documents with remote online notarization by vendors that meet the requirements of the Oregon Secretary of State.
To be accepted by PERS, notarized documents also must meet the following requirements:
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