Forms and Publications

	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 Member
• Service Credit Applications
• Tax-Deferred Payment (TDP) and Rollover Forms
• For Terminating or Deferred Members
• Apply for Retirement
• For Disability Applicants
• For Retirees
• 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 (R0259G) 
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 State 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)

Eligible Domestic Relations Orders: 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.

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.

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.

TDP Agreement Payoff Worksheet (R0718G) 
This document gives you information about how to pay off a current Tax-Deferred Payment (TDP) agreement and includes a worksheet to help you project your TDP agreement balance at the time of your employment separation.

Payoff 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.

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!

Preparing for Retirement: What You'll Need (R0870G) 
Print out this paper form to use as a reference when you apply online. You will be able to make notes that will be helpful as you apply, especially if you're not using your own computer to apply.

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. 

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.

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.

Income Tax Withholding Authorization (R0012X) 
Use this to change either the federal or Michigan 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 (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 (R0912X).

Domestic Relations Order to Void the Survivor Option Only (R0914CGB)  
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 (R0912X).

Domestic Relations Orders: Background and Instructions (R0912X)  
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.

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

Retiree Rehire Certification (R0792G)
Complete this form if you retired from the state of Michigan, receive a pension, and are subsequently rehired by the state either directly or indirectly with a third party.

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

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

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.