Forms

A-E

Affidavit of Attorney in Fact

This completed form must accompany your Power of Attorney document.

All Deferred Compensation Program Forms

Forms are available at the DCP Web site.

Authorization for Direct Deposit

Complete this form to sign up for direct deposit of your retirement benefit.

Beneficiary Designation

In addition to designating the beneficiary of retirement monies, the form includes a section for a $150,000 death benefit for PERS, PSERS, SERS, TRS, LEOFF and WSPRS members who die as a result of an injury sustained in the course of employment, or an occupational disease or infection that arises naturally and proximately out of covered employment.

DCP Distribution Request

DCP Participation Agreement

Enrollment

For new members of LEOFF or WSPRS; members returning to a LEOFF or WSPRS eligible position; or PERS elected or Governor-appointed officials; a city managers; or chief administrative officers of a court, port district, or public utility district.

F-O

IRS form W-4P

Withholding certificate for pension or annuity payments. Use this form to tell payers the correct amount of federal income tax to withhold from your payment(s).

IRS form W-8BEN

Note: This form is on the IRS Web site. It does not belong to DRS.

IRS form W-9

Note: This form is on the IRS Web site. It does not belong to DRS.

Information Release Authorization

Release your account information to a third party, such as your financial planner.

Judicial Benefit Multiplier Election Form (PERS)

This form is for judicial members of the Public Employees' Retirement System who choose to participate in the Judicial Benefit Multiplier Program.

Judicial Benefit Multiplier Election Form (TRS Plan 1)

This form is for judicial members of the Teachers' Retirement System Plan 1 who choose to participate in the Judicial Benefit Multiplier Program.

LEOFF Plan 2 Retiree Re-employment Form

This form must be completed by a LEOFF Plan 2 retiree returning to work in a PERS, PSERS, SERS, or TRS eligible position. Retirees must choose between two options: to become a member of PERS, PSERS, SERS or TRS and temporarily suspend their LEOFF benefit; or not become a member and continue to receive their LEOFF benefit.

Legal Order Payee Beneficiary Designation

Designate beneficiary information in case of death prior to complete distribution of benefits. For those receiving a retirement benefit as a result of a legal order.

Member Information Form

Enrollment form new PERS, SERS or TRS members; for Plan 2 members who choose to transfer to Plan 3; or for Plan 3 members returning to eligible employment.

Name/Address Change

For retirees, beneficiaries and former members. Active members: please update your name and/or address through your employer.

P-R

PERS Plan 1 Request for Post 30-Year Program Benefit Estimate

Plan 3 Change of Investment Program

Plan 3 members use this form to select a new investment program for future contributions; this form should be turned in to the employer.

Plan 3 forms

S-Z

SERS Plan 2 and Plan 3 Substitute's Guide (Includes Form)

Substitute teachers who belong to SERS Plan 2 or Plan 3.

TRS Plan 1 Request for Post 30-Year Program Benefit Estimate

TRS Plan 1 Substitute Teacher's Guide to Obtaining Service Credit (Includes Form)

Substitute Teachers who belong to TRS Plan 1.

TRS Plan 2 and Plan 3 Substitute's Guide (Includes Form)

Substitute teachers who belong to TRS Plan 2 or Plan 3.

TRS Plan 3 January Contribution Rate Change Form

For TRS Plan 3 members wishing to change their contribution rate during the month of January.

Withdrawal of Retirement Contributions (For Plan 1 and Plan 2 - Includes Form)

For Plan 1 and Plan 2 members who have terminated retirement covered-employment and who are eligible for withdrawal of contributions and interest earned. When completing the request to withdraw contributions, members need to also complete an IRS form W-9 to verify Social Security number prior to payment.

Withdrawal of Retirement Contributions (For Plan 3 - Includes Form)

See Plan 3 Request for Payment of Defined Contribution Funds.