Forms and Publications

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For Active Members

Name and Address Change Form (R0357X)
Use this form to change your name and address with our office.

State Employee Beneficiary Nomination Form (R0400G)
This form designates a beneficiary for a monthly pension benefit in the event of the death of an active state employee.

Eligible Domestic Relations Orders (R0259X) 
This document provides background information for those parties wishing to file an Eligible Domestic Relations Order (EDRO).

Publication: Your Retirement Plan: An Overview of the Defined Benefit Plan  
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. 

Service Credit Applications

Military Service Credit Application (R0081G)
Use this form to apply for service credit for time you spent in active duty military service.

Parental Leave Service Credit Application (R0126G) 
If you reduced your hours or left state employment for parental leave - maternity, paternity, or child rearing time - you may be eligible to buy up to five years of retirement credit for these time periods. 

Other Governmental Employment Service Credit Application (R0127G) 
If you were employed by a city, county, township, village in Michigan; another state government; or the federal government, you may be eligible to purchase this service.

Application to Transfer Michigan Public School Service (R0417G) 
This application is used for transfer of eligible service and/or monies on deposit or for informational purposes only.

University Service Credit Application (R0447G) 
If you previously worked for Grand Valley State University, Michigan State University, Oakland University, Saginaw Valley University, University of Michigan, or Wayne State University, you may be eligible to purchase or receive retirement credit for this employment. Work with your previous employer to complete this form and submit it to ORS to determine if you are eligible.

Service Credit Payment Options (R0648G) 
Summarizes the ways you can pay for your service credit purchase.

Publication: Enhancing Your Pension: Earning and Purchasing Service Credit  
For Defined Benefit plan members who are interested in increasing their pension amount, or qualifying earlier, by adding to their service credit. The booklet includes details on the types of service credit available, how to apply, and different ways to pay.

Tax-Deferred Payment (TDP) and Rollover Forms

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.

Payoff Payment Options for a TDP Agreement (R0518G) 
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.

Supplemental TDP Agreement (R0654G) 
Use this form if you have a current Tax-Deferred Payment (TDP) agreement and wish to increase your payroll deductions. 

For Terminating or Deferred Members

Deferred Service Retirement Beneficiary Designation (R0134G)
If you separate from state service after working at least ten years, but before you're old enough to draw your pension, your beneficiary may be eligible for a pension benefit if you die. Use this form to keep your beneficiary designation up-to-date. You may change this beneficiary designation at any time prior to your actual date of retirement.

Refund Application (R0138G)
Use this form if you have terminated employment and would like to withdraw your contributions on account with the State Employees' Retirement System.

Publication: Leaving State 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.

Retirement Application Forms

State Employees' Defined Benefit Retirement Application (R0131G) 
Use this form to apply for retirement benefits based on your age and years of service.

Life Insurance Beneficiary Designation (R0782GHB)
This form is used to designate your life insurance primary and secondary beneficiaries upon retirement.

Health, Dental, Vision, and Life Insurance Options (R0423GH)
This form provides you with basic information about the health, dental, and vision insurance coverage available to retirees. 

Insurance Rates 
Health, dental, and vision insurance rates for retirees are available on the Employee Benefits Civil Service website. 

Publication: Retirement Readiness: A Two-Year Countdown
For Defined Benefit plan 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.

For Disability Applicants

Publication: If You Become Disabled: Your Disability Protection 
For Defined Benefit 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.

Forms for Retirees

Name and Address Change Form (R0357X) 
Use this form to change your name and address with our office.

Pension Recipient's Federal Income Tax Withholding Authorization (R0012X) 
Use this form to change the federal income tax withholding on your retirement pension.

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

Insurance Enrollment/Change Request (R0452G)
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.

Insurance Rates 
Health, dental, and vision insurance rates for retirees are available on the Employee Benefits Civil Service website. 

Health, Dental, Vision, and Life Insurance Options (R0423GH)
This form provides you with basic information about the health, dental, and vision insurance coverage available to retirees. 

Domestic Relations Order (DRO) (R0323X) 
A Domestic Relations Order typically provides background information for retirees dividing a pension as part of a divorce.

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

Life Insurance Beneficiary Designation (R0782GHB)
This form is used to designate your life insurance primary and secondary beneficiaries upon retirement.

Early Out Sick Leave Beneficiary Nomination Form (R0511G) 
This form is for use ONLY by those retirees who retired under the 2002 Early Out program. Use this form to change the beneficiary designation for the balance of your sick leave funds.

Publication: 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.

Publications

Your Retirement Plan: An Overview of the Defined Benefit Plan 
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.

Enhancing Your Pension: Earning and Purchasing Service Credit  
For Defined Benefit plan members who are interested in increasing their pension amount, or qualifying earlier, by adding to their service credit. The booklet includes details on the types of service credit available, how to apply, and different ways to pay.

Retirement Readiness: A Two-Year Countdown
For Defined Benefit plan 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.

If You Become Disabled: Your Disability Protection 
For Defined Benefit 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.

Leaving State 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.

Comprehensive Annual Financial Report (CAFR) 
The latest annual report presents the financial position and results of operations of the State Employees' Retirement System.

Eligible Domestic Relations Orders (R0259X) 
An Eligible Domestic Relations Order typically provides background information for active members dividing a pension as part of a divorce.

Domestic Relations Order (DRO) (R0323X) 
A Domestic Relations Order typically provides background information for retirees dividing a pension as part of a divorce.