Forms and Publications

Apply for retirement For most account changes, you don't need a paper form. Simply access your account online to name a beneficiary, change your address, view and apply for service credit, estimate your pension, apply for retirement, and much more.
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For Active Members 

Beneficiary Nomination (R0315C)  
This form designates a beneficiary for a monthly pension in the event of the death of an active public school employee.

Name Change Request for Active Employees (R1131X)
Use this form to change your name if you are not receiving a pension benefit from ORS and are actively working for the Public School Employees Retirement System.

Eligible Domestic Relations Order: Background and Instructions (R0911X)
Important instructions and background information, and examples for completing an Eligible Domestic Relations Order that complies with retirement statutes. This information will help you understand how an EDRO will affect your pension.

Eligible Domestic Relations Order (EDRO) (R0259C)
An EDRO is a specific type of court order that provides instructions for dividing a public pension as part of a divorce. It applies only to active and deferred members of a pension system. ORS developed this online fillable form to allow members of the Michigan Public School Employees' Retirement System to created accurate and complete EDROs that can be administered under the retirement statutes. It is the preferred document to file with ORS. Background information and instructions are provided separately in Eligible Domestic Relations Orders: Background and Instructions (R0911X).

Publication: Your Retirement Plan: A Member Handbook for Michigan's Public School Employees 
This plan overview is a useful reference at any stage in your career. It provides general information about your retirement plan, as well as suggestions for long-term retirement planning.

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Service Credit Applications

Universal Buy-In - Log in to miAccount and request a Member Billing Statement.

Parental Leave (R0008C) 
If you reduced your hours or left public school employment for parental leave you may be eligible to buy up to five years of retirement credit for those time periods.

Out-of-System or Nonpublic Educational Credit (R0149C) 
As an active member of the Michigan Public School Employees Retirement System, you may purchase out-of-system and nonpublic educational service at any time.

Military Service Credit (R0081C)
Use this form to apply for service credit for time you spent in active duty military service.

Sabbatical Leave Credit (R0148C) 
As an active member of the Michigan Public School Employees Retirement System, you may receive credit for an authorized sabbatical leave of absence.

State of Michigan Credit (R0317C) 
Use this form to receive retirement credit for the years you worked for the state of Michigan and were a member of the State Employees' Retirement System.

Weekly Workers Compensation Credit (R0285C)  
Use this form to request service credit for weekly workers' compensation (WWC) paid to you before July 1, 1992 only.

Comprehensive Employment and Training Act (CETA) - Contact ORS to request.

If you are interested in increasing your pension amount, or qualifying earlier, by adding to your service credit, please visit the Service Credit - Earning & Purchasing section on our website where you can find up-to-date information that details the types of service credit available, how to apply, and different ways to pay.

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Tax-Deferred Payment and Rollover Forms

Service Credit Payment Options (R0648C) 
Summarizes the ways you can pay for your service credit purchase.

TDP Agreement (R0392C) - Contact ORS to request.

Qualified Plan-to-Plan Transfer Certification (R0158X)
This form is used if you wish to transfer funds from a qualified retirement plan (401(a), 401(k), 403(b), or 457) to purchase service credit.

Supplemental TDP Agreement (R0654C)
Use this form only if you have a current Tax-Deferred Payment (TDP) agreement and wish to increase a tax-deferred payroll deduction.

Payoff Payment Options for a TDP Agreement (R0518C) and TDP Payoff Worksheet (R0718C)
You can use this form only if you are retiring or terminating employment and need to pay off a current Tax-Deferred Payment (TDP) agreement. 

TDP Agreement Addendum (R0625C)
Use this form to transfer a TDP agreement to a new Michigan public school employer.

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For Terminating or Deferred Members

Beneficiary Nomination Form (R0315C) 
This form designates a beneficiary for a monthly pension in the event of the death of an active public school employee.

Refund Application (R0311C)
Use this form if you have terminated employment and would like to withdraw your contributions on account with the Public School Employees Retirement System. 

Name, Address, and Contact Information Change (R0357X) 
Use this form to change your physical address, mailing address, email address, name, or phone number with ORS.

Payoff Payment Options for a TDP Agreement (R0518C) and TDP Payoff Worksheet (R0718C)
You can use this form only if you are retiring or terminating employment and need to pay off a current Tax-Deferred Payment (TDP) agreement.

Publication: Leaving Public School Employment?
If you're not yet eligible to retire, either because you don't have enough service credit or you're too young to qualify for a monthly pension, this publication will help you understand how your retirement plan will be affected.

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Apply for Retirement

Application for Retirement - miAccount
miAccount is the fastest and easiest way to apply for retirement - 5 simple steps and you're done!

Applying for Retirement: What You'll Need (R0870C)
Print this worksheet to use as a reference when you apply online. This will help you gather the information you'll need to complete your application. You can also take notes that will be helpful as you apply, especially if you're not using your own computer.

Insurance Information (R0058C)
This document provides you with basic information about the health, dental, and vision insurance coverage available to retirees.

Insurance Options Summary (R0379C)

Federal Income Tax Withholding Authorization Worksheets (R0727X)
Use this form to determine how many allowances to claim or if you should request additional money to be withheld on your Federal Income Tax Withholding Authorization in your retirement application.

Publication: Retirement Readiness: A Two-Year Countdown 
For members who are within a few years of retiring. This book contains specifics on how pensions are calculated, the various payment options, how to prepare for retirement, and the application process.

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For Disability Applicants

Publication: If You Become Disabled: Your Disability Protection
For members who are facing an illness or injury that prevents them from working. This brochure defines the criteria to receive a disability benefit and gives an overview of the application process.

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For Retirees

3rd Party/Independent Contractor Retiree Rehire/Termination Certification (R0851C)  
If you retired on or after July 1, 2010, and you will be returning to work, either directly or indirectly, in a Michigan public school or any charter school in Michigan, you and your employer will both need to complete this form. Your employer is responsible for returning the form to ORS.

Insurance Enrollment/Change Request (R0452C) 
Use this form to enroll in one or more of the retirement system insurance plans, change from one health plan to another, or add, delete, or change a name for anyone on your existing insurance coverage. Also use this form to notify the Office of Retirement Services (ORS) if you or any of your covered dependents become eligible for Medicare or other health, dental, vision or prescription group insurance coverage.

Direct Deposit Application (R0277X) 
Use this application to have your monthly pension automatically deposited into your checking account or savings account.

Name, Address, and Contact Information Change (R0357X) 
Use this form to change your physical address, mailing address, email address, name, or phone number with ORS.

Insurance Information (R0058C)  
This document provides you with basic information about the health, dental, and vision insurance coverage available to retirees.

Insurance Options Summary (R0379C)

Insurance Rates (R0072C) 

Income Tax Withholding Authorization (R0012X)
Use this to change the federal and Michigan income tax withholding on your retirement pension.

Domestic Relations Orders: Background and Instructions (R0912CBG) Important instructions, background information, and examples for completing a Domestic Relations Order that complies with retirement statutes. This information will help you understand how a DRO affects your pension.

Domestic Relations Order (DRO) (R0323C)  
A Domestic Relations Order (DRO) is a specific type of court order that provides instructions for dividing a public pension as part of a divorce. It applies only to retired members of a pension system. ORS has developed a downloadable, fillable form to allow you to create accurate and complete DROs that can be administered under the retirement statutes. This interactive PDF prevents errors by not allowing contradicting selections, by prefilling information, preventing typographical errors, and by offering pop-up help screens. It is the preferred document to file with the Office of Retirement Services. This is the fastest, most efficient way to complete your filing. Complete it online, save it, print it, then take the printed copy to the court for the judge's signature. Background information, instructions, and examples are provided separately in Domestic Relations Orders: Background and Instructions (R0912CBG).

Domestic Relations Order to Void the Survivor Option Only (R0914C)  
This downloadable, fillable form simplifies the voiding of a survivor option of a Domestic Relations Order (DRO) in circumstances when the void language is not included in the judgment of divorce. This interactive PDF prevents errors by prefilling information, preventing typographical errors, and by offering pop-up help screens. It is the preferred document to file with the Office of Retirement Services. This is the fastest, most efficient way to complete your filing. Complete it online, save it, print it, then take the printed copy to the court for the judge's signature. Background information, instructions, and examples are provided separately in Domestic Relations Orders: Background and Instructions (R0912CBG).

Refund Beneficiary Designation for Retirees (R0748X)
Use this form to change your retirement refund beneficiary.

Publication: After You Retire: What Every Pension Recipient Should Know booklet
You will receive this booklet when you apply for your pension. It tells you what to expect, and how and when you should contact ORS after your retirement benefits begin.

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Publications

Your Retirement Plan: A Member Handbook for Michigan's Public School Employees 
This plan overview is a useful reference at any stage in your career. It provides general information about your retirement plan, as well as suggestions for long-term retirement planning.

Retirement Readiness: A Two-Year Countdown 
For members who are within a few years of retiring. This book contains specifics on how pensions are calculated, the various payment options, how to prepare for retirement, and the application process.

After You Retire: What Every Pension Recipient Should Know 
You will receive this booklet when you apply for your pension. It tells you what to expect, and how and when you should contact ORS after your retirement benefits begin.

Leaving Public School Employment?
If you're not yet eligible to retire, either because you don't have enough service credit or you're too young to qualify for a monthly pension, this publication will help you understand how your retirement plan will be affected.

If You Become Disabled: Your Disability Protection 
For members who are facing an illness or injury that prevents them from working. This brochure defines the criteria to receive a disability benefit and gives an overview of the application process.

Comprehensive Annual Financial Report (CAFR)  

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