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Forms

All Forms All Employer Forms Disability Retirement Forms Health Insurance Credit Forms Group Life Insurance Forms myVRS Navigator Resources Miscellaneous Forms Non-VRS Forms Optional Retirement Forms Payroll Forms Purchase of Prior Service Forms Service Retirement Forms Virginia Sickness & Disability Forms (state only) All Member Forms Disability Retirement Forms Group Life Insurance Forms Miscellaneous Forms Non-VRS Forms Optional Retirement Forms Purchase of Prior Service Forms Service Retirement Forms Virginia Sickness & Disability Forms (state only) All Retiree Forms Update Your Information Forms Life & Health Insurance Forms

member retirement Forms

Form #	Description	Last Updated	Non-fill	Fillable
VRS-2	Designation of Beneficiary To designate more than 3 beneficiaries, a continuation form, the VRS-2A, is also required.	04/2011	51kb	179kb
VRS-2A	Designation of Beneficiary - Continuation	02/2011	29kb	48kb
VRS-3ORP	Request for Plan-to-Plan Transfer to ORP	02/2011	24kb	33kb
VRS-5	Application for Retirement	12/2012	58kb	227kb
VRS-6	Application for Disability Retirement	12/2012	58kb	236kb
VRS-6A	Explanation of Disability	12/2012	27kb	156kb
VRS-6B	Physician's Report	02/2011	31kb	93kb
VRS-6C	Request for Estimate of Disability Retirement Benefits	02/2011	23kb	33kb
VRS-6D	Employer Information for Disability Application	02/2011	21kb	26kb
VRS-7ORP	Notice of Return to Covered Employment Optional Retirement Plan Retiree	11/2012	40kb	217kb
VRS-15	Request for Income Tax Withholding	02/2011	30kb	45kb
VRS-45	Request for Health Insurance Credit Retired participants who do not have premiums deducted from their VRS monthly benefit must complete this form.	02/2011	62kb	76kb
VRS-57	Authorization for Direct Deposit of Monthly Benefit	02/2011	22kb	31kb
VRS-60	Request for Estimate of Retirement Benefits	03/2013	50kb	167kb
VRS-65	Election to Participate - Optional Retirement Plan for Higher Education	11/2012	40kb	230kb
VRS-65D	Termination Certification Form- Optional Retirement Plan for Higher Education	04/2013	75kb	238kb
VRS-65E	Termination Certification Form - Optional Retirement Plan for Political Appointees	04/2013	77kb	172kb
VRS-71B	Termination Certification Form - Optional Retirement Plan for School Superintendents	04/2013	74kb	239kb
VRS-75	Optional Retirement Plan Health Insurance Credit Employer Certification of Service Completed only by employers certifying Optional Retirement Plan participants.	07/2012	33kb	150kb
VRS-170	VSDP Long-Term Care Plan Authorization of Coverage Retention	08/2008	27kb	140kb
VRS-171	VSDP Long-Term Care Plan Protection Against Unintentional Lapse	08/2008	26kb	130kb

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