Forms | Virginia Retirement System

All forms are fillable and ready for download and printing. VRS accepts all forms by mail or fax. Fax to: 804-786-9718. If on deadline when faxing a form, please call or email to alert VRS of its pending arrival.

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VRS accepts forms by mail or fax.

Form #	Title / Description	Link
-	Approved Domestic Relations Orders - Defined Benefit Plan Revision Date: Nov 2023
-	Approved Domestic Relations Order-DCP-TIAA Revision Date: Oct 2024
-	Approved Domestic Relations Order-DCP-VOYA Revision Date: Oct 2024
all-forms	Securian Financial/VRS Life Insurance Forms VRS-31, VRS-32, VRS-35, VRS-37, VRS-38, VRS-39, VRS-39A, VRS-39R and VRS Certificate of Life Insurance.
IRS 402(F)	Special Tax Notice - VRS Defined Benefit Plans Before taking a refund, read this notice which explains the tax consequences of taking a refund. Revision Date: June 2024
A10741	State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants Revision Date: Feb 2024
VSDP-2	College and University Opt-Out Form Revision Date: Sep 2011
VRS-2	Designation of Beneficiary - Defined Benefit Plan VRS members and retirees now update beneficiaries online through their secure myVRS account. Revision Date: July 2021
VRS-2A	Designation of Beneficiary - Continuation VRS members and retirees now update beneficiaries online through their secure myVRS account. Revision Date: Feb 2020
VRS-3	Request for Refund – Defined Benefit Plan Log in to myVRS to submit your refund request.
VRS-3A	Name and Address Declaration For Deferred Members Revision Date: Feb 2011
VRS-3ORP	Request for Transfer of Funds to ORP Revision Date: Feb 2025
VRS-5	Application for Service Retirement Before completing the form, log in to myVRS for retirement counseling resources and review the Apply for Retirement page to determine if you can retire online. Revision Date: Nov 2022
VRS-6	Application for Disability Retirement Revision Date: Apr 2022
VRS-6A	Explanation of Disability Revision Date: Jan 2019
VRS-6B	Physician's Report Revision Date: Jan 2019
VRS-6C	Request for Estimate of Disability Retirement Benefits Revision Date: Feb 2011
VRS-6D	Employer Information for Disability Application Revision Date: Oct 2020
VRS-6E	Certification of Alternate Employment for Disability Retiree for Political Subdivision Hazardous Duty Employees Revision Date: Aug 2012
VRS-7ORP	Notice of Return to Covered Employment Optional Retirement Plan Retiree Revision Date: Nov 2012
VRS-8	Certification of Exception from General Early Retirement Provisions Revision Date: Apr 2022
VRS-11	Employer Certification of Involuntary Separation Under the Workforce Transition Act Revision Date: Feb 2016
VRS-11A	Employer Certification of Basic Group Life Insurance Coverage Under Workforce Transition Act Revision Date: Feb 2011
VRS-11B	Employer Certification of Involuntary Separation Under the Transitional Benefits Program Revision Date: June 2015
VRS-11C	Employer Certification of VRS Basic Group Life Insurance Coverage Under the Transitional Benefits Program Revision Date: Feb 2011
VRS-15	Request for Income Tax Withholding Revision Date: Aug 2022
VRS-26	Application for Purchase of Prior Service Credit Revision Date: Mar 2022
VRS-26C	Authorization for After-Tax Payroll Deduction to Purchase Service Credit VRS members now select payment agreement type in myVRS and provide confirmation details page to employer.
VRS-26E	Agreement for Pretax Salary Reduction to Purchase Service Credit VRS members now select payment agreement type in myVRS and provide confirmation details page to employer.
VRS-26H	Application to Purchase Prior Service Credit (For Superintendents of Schools) Revision Date: Feb 2011
VRS-26M	Application for Contribution Make-Up for Hybrid Plan Participants Returning from Military Leave Revision Date: Feb 2025
VRS-45	Request for Health Insurance Credit Retirees can update health insurance policy information online through myVRS. Revision Date: Feb 2025
VRS-48	Request for Member Information Change Revision Date: Mar 2013
VRS-57	Authorization for Direct Deposit of Monthly Benefit Retirees can update direct deposit information online through myVRS. Revision Date: June 2021
VRS-58	Name and Address Declaration Just changing your address? Make the update using myVRS for quicker processing. Revision Date: July 2021
VRS-61	Notification of Electronic Payment Information Revision Date: Sep 2021
VRS-65D	Termination Certification Form - Optional Retirement Plan for Higher Education Revision Date: July 2024
VRS-65E	Termination Certification Form - Optional Retirement Plan for Political Appointees Revision Date: July 2024
VRS-67A	Authorization of Administrative Contacts Revision Date: Mar 2025
VRS-70	Request for Review of Membership Records Revision Date: Feb 2011
VRS-71B	Termination Certification Form - Optional Retirement Plan for School Superintendents Revision Date: July 2024
VRS-75	Optional Retirement Plan Health Insurance Credit Employer Certification of Service Completed by Optional Retirement Plan participants and by their employers, who certify employment. Revision Date: Feb 2025
VRS-76	Certification of Employment for Health Insurance Credit Eligibility Completed only by employers certifying general registrars, local officers, employees of these referenced positions and local social service employees. Revision Date: July 2021
VRS-77	Certification of Hazardous Duty Revision Date: Apr 2021
VRS-78	Authorization to Deduct Insurance Premiums Completed only by employers for non-state participants. Revision Date: July 2021
VRS-160	Certification of Eligibility for Critical Shortage Teachers and Administrators Revision Date: July 2023
VRS-160C	Certification of Eligibility for Retiree School Security Officers Revision Date: July 2023
VRS-160D	Certification of Eligibility for Critical Shortage Bus Drivers Revision Date: July 2023
VRS-160S	Certification of Eligibility for Critical Shortage Specialized Student Support Positions Revision Date: July 2023
VRS-170	Authorization of Coverage Retention for the Long Term Care Plan (VSDP or VLDP) Revision Date: Mar 2023
VRS-171	Protection Against Unintentional Lapse of Long Term Care (VSDP or VLDP) Revision Date: Mar 2023
VRS-180	Employer Request for Forfeiture of Member Benefits Revision Date: Dec 2015
VRS-900	Authorization to Discuss VRS Account Information Revision Date: Feb 2011
VRS-901	VRS Durable Power of Attorney Revision Date: Feb 2025
-	Beneficiary Designation - Defined Contribution Plan Log in to your DCP Account to view and submit this form.
-	Direct Rollover / Transfer Request - Defined Contribution Plan Log in to your DCP Account to view and submit this form.
-	Distribution Request - Defined Contribution Plan Log in to your DCP Account to view and submit this form.
-	In-Service Distribution Request - Defined Contribution Plan Log in to your DCP Account to view and submit this form.
-	Workforce Transition Act (WTA) Distribution/Rollover Request Form - Defined Contribution Plan Log in to your DCP Account to view and submit this form.
-	Beneficiary Claim Request Form - Defined Contribution Plan Log in to your DCP Account to view and submit this form.
-	IRS Form W-4P: Withholding Certificate for Pension or Annuity Payments
-	Incoming Rollover Form - Defined Contribution Plan To request a direct rollover of your assets from your previous employer’s retirement plan to your Hybrid 457 Deferred Compensation Plan.
-	Information Release Authorization - Defined Contribution Plan

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