Forms and Publications

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• For Active Member
• Retirement Application Forms
• Drop Participants
• For Retirees
• Release Authorization
• Publications

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For Active Member 

• Refund Application (R138GH)
  Use this form if you have terminated employment and would like to withdraw your contributions on account with the State Employees' Retirement System or the Michigan State Police Retirement System. This will forfeit your rights to a future pension with the retirement system.
• Military Service Credit Application (R0081H)
• Parental Leave Service Credit Application (R0126H)
  If you reduced your hours or left State Police employment for parental leave - maternity, paternity, or child rearing time - you may be eligible to buy up to two years of retirement credit for these time periods.
• Qualified Plan-to-Plan Transfer Certification (R0158X)
• Beneficiary Nomination (R0400H)
  Use this form  to nominate one pension beneficiary and one or more refund beneficiaries.
• 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) (R0259H)
  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 Police 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).
• 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 State Police Retirement System.
• Service Credit Payment Options (R0648H)
• Publication: Your Retirement Overview (R0159H)
• Brochure: DROP: Deferred Retirement Option Plan for State Police (R0627H)

Retirement Application Forms

• Application for Retirement - miAccount
  miAccount is the fastest and easiest way to apply for retirement - 5 simple steps and you're done!
• Application for Retirement or DROP (R0732H)
• Health, Dental, Vision, and Life Insurance Options (R0423GH)
• Insurance Rates
  Health, dental, and vision insurance rates for retirees are published by the Civil Service Commission - Employee Benefits Division.
• Life Insurance Beneficiary Designation (R0782GHB)
• Reliance Standard Group Insurance Beneficiary Designation/Change
  If you purchased supplemental life insurance as an active member, you may choose to continue your coverage in retirement. As of 11/01/2020, Reliance Standard is the current administrator of this policy. For more information, contact your state police human resource office. If you choose to continue this benefit in retirement, complete the Reliance Standard Beneficiary Designation Form and mail to Office of Retirement Services, P.O. Box 30171, Lansing, MI 48909-7671 or fax to (517) 284-4416. For questions completing the form, contact the Benefit Resource Group at 810-735-6500.
• 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: Your Retirement Overview (R0159H)

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DROP Participants

• Application for Retirement or DROP (R0732H)
• Deferred Retirement Option Plan (DROP) Beneficiary Designation  (R0626H)
  Use this form after you retire to change your beneficiary who will receive the balance of your DROP benefit if you die before withdrawing the entire balance.
• Early Termination form for Deferred Retirement Option Plan (DROP) (R0667H)
• Deferred Retirement Option Plan (DROP) Account Distribution Request (R0665H)
• Brochure: DROP Deferred Retirement Option Plan for State Police (R0627H)

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For Retirees

• Direct Deposit Application (R0277X) 
• 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 Enrollment/Change Request (R0452H)
  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 published by the Civil Service Commission - Employee Benefits Division.
• Opt-In Form (R2031H) 
  Use this form if you are a Medicare-eligible State Police Troopers and Sergeants Retired on or after 10/1/1987.
• 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 (R0912HD)
  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) (R0323H)
  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 (R0912HD).
• Refund Beneficiary Designation for Retirees (R0748X)
• Life Insurance Beneficiary Designation (R0782GHB)

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Release Authorization

Release Of Information Authorization (R3488CGHBD)  
If you need to request a copy of documents located in your account, please complete and submit this form.

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Publications

• Your Retirement Overview (R0159H)
• DROP Deferred Retirement Option Plan for State Police (R0627H) 
• Comprehensive Annual Financial Report
• 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.

• Domestic Relations Order (DRO)(R0323X)

A DRO is for retirees dividing a pension as part of a divorce.

• Proactive - our e-newsletter for active members.

March 2022
December 2021
September 2021
June 2021
March 2021
December 2020
Summer 2020
December 2019
Summer 2019
Fall 2018
Spring 2018
Fall 2017
Spring 2017
Fall 2016
Spring 2016
Fall 2015
Spring 2015
Fall 2014

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