To avoid delays or errors, before you complete an application for retirement or disability retirement form, PSERS strongly suggests you attend one of our retirement exit counseling sessions in your area presented by a PSERS retirement representatives.
Active Member Forms
Authorization for Release of Information - PSRS 1273
Multiple Service Membership - PSRS 1259
Nomination of Beneficiaries - PSRS 187
Nomination of Beneficiaries Addendum - PSRS 1253
Vital Papers and Other Important Information - PSRS 1012
Waiver of Pension Benefits - PSRS 1286
PSERS Verification of Deposit - PSRS 1326
Refund Application – Contact PSERS to acquire this form
Retirement Application for a Disability Retirement – Requires counseling. Contact PSERS to acquire this form
Purchase of Service
Application to Purchase Credit for an Approved Leave of Absence - PSRS 112
Purchase of Out-of-State Service - PSRS 278
Purchase of United States Government Service - PSRS 600
Rollover Certification Form - PSRS 928
Retirement
Application for Retirement - PSRS 8
Disability Retirement Explanation - PSRS 123
Request for Retirement Estimate - PSRS 151
Release for Medical Records - PSRS 607
Authorization for Direct Rollover (Retirement) - PSRS 1264
Retirement Packet (99400)
Contact PSERS to receive an Application for Disability Retirement. To receive any other forms associated with a disability retirement or an Application for Refund, contact PSERS .
Retired Member Forms
Authorization for Direct Deposit - Electronic Transfer of Monthly Benefit - PSRS 116
Power of Attorney - PSRS 248
Option Designation (For Retirees Whose Survivor Annuitant is Deceased) - Contact PSERS to acquire this form
PSERS Health Options Program - PSRS 1165
Change of Address for PSERS Retirees and Non-Active Members - PSRS 1301
Power of Attorney
Power of Attorney - PSRS 248
Agent's Acknowledgement - PSRS-248-1
POA Relationship Affidavit - PSRS-248-4
POA Florida Affidavit - PSRS 248-2
POA Non-Durable Affidavit - PSRS 248-3
Taxes
Rollover Certification for Purchase of Creditable Service - PSRS 928
Tax Information for Refunds - PSRS 1245
W-4P Federal Tax Withholding Certificate for Pension or Annuity Payments - PSRS 996
- Executor Request for PSERS Documents - PSRS 1332