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All PERAC Forms

A list of all fillable PERAC forms
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Table of Contents

2016 Annual Statement of Earned Income New Member Data (PDF 410.5 KB)
Accidental Disability Retirement Checklist (PDF 85.8 KB)
Accounting, Actuarial & Legal Service Provider Checklist (PDF 185.31 KB)
Anti-Spiking Calculation Worksheet (XLS 30 KB)
Application for a Waiver of Education Restrictions (PDF 407.46 KB)
Application for Member Survivor Benefits (PDF 366.21 KB)
Application for Reinstatement to Service (PDF 48.38 KB)
Authorization to Use or Disclose Protected Health Information (PDF 53.76 KB)
Beneficiary Change Form (PDF 302.88 KB)
Beneficiary Selection Form (PDF 333.73 KB)
Beneficiary Selection Form (Option D form) (PDF 312.12 KB)
Board Change Form (PDF 468.17 KB)
Consultant Checklist (PDF 189.29 KB)
Custodial Services Checklist (PDF 187.24 KB)
Disability Application Glossary of Terms (PDF 126.97 KB)
Disability Retiree Current Information Form (PDF 207.06 KB)
Disability Retiree Earned Income Worksheet (PDF 172.83 KB)
Disability Retirement Application (PDF 433.55 KB)
Disability Retirement Benefits for Veterans (PDF 104.73 KB)
Disability Transmittal to the Commission (PDF 242.79 KB)
Employer's Request for Information (PDF 61.28 KB)
Employer's Shift Substitution Certification (PDF 138.33 KB)
Employer's Termination Retirement Certification (PDF 59.48 KB)
Employer Statement for Disability Retirement Application (PDF 333.61 KB)
Exemption from Investment Restriction for Hedge Fund of Funds (PDF 76.91 KB)
Exemption from Investment Restriction for Hedge Funds (PDF 72.64 KB)
Involuntary Retirement Application (PDF 311.79 KB)
Money Manager Checklist (PDF 207.58 KB)
New Member Enrollment Form (PDF 349.66 KB)
Notice of Election of Benefits under 12(2)(d) (PDF 252.15 KB)
Notice of Retirement Board Action on Disability Application (PDF 73.17 KB)
Notice to PERAC of Reinstatement of Duties (PDF 245.59 KB)
Notice to PERAC of the Granting of 12(2)(d) Benefits (PDF 75.2 KB)
Online Fraud Referral Form  
Physician's Statement Pertaining to a Member's Disability Retirement Application (PDF 276.36 KB)
Placement Agent Statement for Investment Managers (PDF 2.35 MB)
Pooled Fund Worksheet  
Pre-Tax Rollover Form (PDF 71.28 KB)
PROSPER Individual Account Approval Application (PDF 232.67 KB)
Refund Form (Beneficiary) (PDF 198.56 KB)
Refund Form (Member) (PDF 263.55 KB)
Regional Medical Panel Certificate (PDF 517.28 KB)
Repayment Worksheets for Buybacks in 2017 (PDF 388.56 KB)
Repayment Worksheets for Buybacks in 2018 (PDF 326.22 KB)
Repayment Worksheets for Buybacks in 2019 (PDF 146.18 KB)
Repayment Worksheets for Buybacks in 2020 (PDF 499.88 KB)
Retiree Post Retirement Earnings Calculator (not Disability) (XLSX 17.11 KB)
Retirement Application (voluntary superannuation) (PDF 318.71 KB)
Retirement Option Selection Form (PDF 340.58 KB)
Securities Litigation Annual Vendor Disclosures (PDF 766.26 KB)
Securities Litigation Service Provider Checklist (PDF 186.81 KB)
Special Tax Notice Regarding Lump Sum Distributions (PDF 164.78 KB)
Spousal Affidavit to Determine Benefit Eligibility (PDF 323.34 KB)
Statement Concerning Your Employment in a Job Not Covered by Social Security (PDF 173.25 KB)
Termination Retirement Transmittal (PDF 81.26 KB)
Vendor Certification (PDF 722.29 KB)
Vendor Change of Address or Contact Information (PDF 600.25 KB)
Vendor Contact Information (PDF 599.81 KB)
Vendor Disclosures (PDF 1.02 MB)
Veterans' Buyback Form (PDF 495.47 KB)
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