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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 

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.

Withholding Certificate Form W-4R (R2035X).
Use this form only if you wish to have more than 20% federal tax withheld from your refund payment. You will be required to complete a Withholding Certificate Form W-4R (R2035X) and submit to ORS with your completed Refund Application (R0138GH).

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 2 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, background information, and examples for completing an Eligible Domestic Relations Order (EDRO) 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. The Michigan Office of Retirement Services (ORS) developed this online fillable form to allow members of the Michigan State Police Retirement System to create 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 Michigan State Police Retirement System.

Service Credit Payment Options (R0648H)

Publication: Your Retirement Overview (R0159H)

Brochure: Deferred Retirement Option Plan (DROP) (R0627H)


 

Retirement Application Forms

Application for Retirement — miAccount
miAccount is the fastest and easiest way to apply for retirement — five simple steps and you're done.

Retirement or DROP Application (R0732H)

Insurance Option Sheet (R0423GH)

Insurance Rates
Health, dental, and vision insurance rates for retirees are published by the Michigan 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 Nov. 1, 2020, Reliance Standard is the current administrator of this policy. For more information, contact your state police human resources office. If you choose to continue this benefit in retirement, complete the Reliance Standard Beneficiary Designation Form and mail to the Michigan 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.

Publication: Your Retirement Overview (R0159H)

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DROP Participants

Retirement or DROP Application (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.

DROP Early Termination Form (R0667H)

DROP Account Distribution Request (R0665H)

Deferred Retirement Option Plan (DROP) (R0627H)

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For Retirees

Direct Deposit Application (R0277X)

You may update your direct deposit information by logging in to miAccount or contacting us to have a form mailed to your home address.

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's 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 ORS if you, your spouse, 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 — Employee Benefits Division.

Opt-In Form (R2031H) 
Use this form if you are a Medicare-eligible state police troopers or sergeants retired on or after Oct. 1, 1987.

Pension Recipient's 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 (DRO) that complies with retirement statutes. This information will help you understand how a DRO affects your pension.

Domestic Relations Order (DRO) (R0323H)
A 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 pre-filling information, preventing typographical errors, and by offering pop-up help screens. It is the preferred document to file with ORS. 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 (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)

Deferred Retirement Option Plan (DROP) (R0627H) 

Annual Comprehensive Financial Reports

Eligible Domestic Relations Order: Background and Instructions (R0911X)
Important instructions, background information, and examples for completing an Eligible Domestic Relations Order (EDRO) 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.

December 2022
September 2022
June 2022
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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