PSRS Retiree Forms

These forms are stored in PDF format. If you have the free Adobe Acrobat Reader software you can fill the forms out and print them, you cannot save them to another location. Please note that you must click the "clear" button in order to delete the information you entered into this form.

Click the Acrobat Reader icon to download this free program.
Please retain a copy of all completed forms for your records.

Forms
	Address Change Form
	Name Change Form If your name has changed due to a marriage or a divorce, you may also need to fill out and submit a new Nomination of Beneficiary form. Click the link below to access that form.
	Tax Withholding Form
	Direct Deposit Authorization Form
	$5,000 Death Benefit Beneficiary Form
	Nomination of Beneficiary* Use this form only if you elected the Single-Life Plan (Option 1) and have a remaining account balance. To change your $5,000 Death Benefit beneficiary, use the $5,000 Death Benefit Beneficiary form above.
	Post-Retirement Designation of Residual Beneficiary Use this form only if you elected a Joint-and-Survivor Plan at retirement (Option 2, 3 or 4).
	Term-Certain Beneficiary Designation Use this form only if you elected a Term-Certain Plan at retirement (Option 5 or 6) and that term has not expired.
Survivor/Death Benefit Forms
	Fall Semester Certification of School Official Form
	Spring Semester Certification of School Official Form
	Summer Certification of Parent/Guardian Form