These forms are used by retirement system staff to process requests to the Public Employee Retirement Administration Commission.
- This page, PERAC Administrator Forms, is offered by
- Public Employee Retirement Administration Commission
PERAC Administrator Forms
Table of Contents
Disability Forms for Administrators
Open PDF file, 410.5 KB,
2016 Annual Statement of Earned Income New Member Data
(English, PDF 410.5 KB)
Open PDF file, 85.8 KB,
Accidental Disability Retirement Checklist
(English, PDF 85.8 KB)
Open PDF file, 207.06 KB,
Disability Retiree Current Information Form
(English, PDF 207.06 KB)
Open PDF file, 326.87 KB,
Disability Retirement Application
(English, PDF 326.87 KB)
Open PDF file, 242.79 KB,
Disability Transmittal to the Commission
(English, PDF 242.79 KB)
Open PDF file, 73.17 KB,
Notice of Retirement Board Action on Disability Application
(English, PDF 73.17 KB)
Open PDF file, 355.76 KB,
Notice to PERAC of Reinstatement of Duties
(English, PDF 355.76 KB)
General Membership Forms for Administrators
Open PDF file, 75.2 KB,
Notice to PERAC of the Granting of 12(2)(d) Benefits
(English, PDF 75.2 KB)
Open PDF file, 81.26 KB,
Termination Retirement Transmittal
(English, PDF 81.26 KB)
Compliance Forms for Administrators & Retirement Board Members
Open PDF file, 567.74 KB,
Board Change Form
(English, PDF 567.74 KB)
Open PDF file, 374.5 KB,
PROSPER Individual Account Approval Application
(English, PDF 374.5 KB)
Employer Forms
Open PDF file, 61.28 KB,
Employer's Request for Information
(English, PDF 61.28 KB)
Open PDF file, 250.28 KB,
Employer's Shift Substitution Certification
(English, PDF 250.28 KB)
Open PDF file, 59.48 KB,
Employer's Termination Retirement Certification
(English, PDF 59.48 KB)
Open PDF file, 418.81 KB,
Employer Statement for Disability Retirement Application
(English, PDF 418.81 KB)
Open PDF file, 421.97 KB,
Involuntary Retirement Application
(English, PDF 421.97 KB)
Buyback Worksheets
Open PDF file, 499.88 KB,
Repayment Worksheets for Buybacks in 2020
(English, PDF 499.88 KB)
Open PDF file, 146.18 KB,
Repayment Worksheets for Buybacks in 2019
(English, PDF 146.18 KB)
Open PDF file, 326.22 KB,
Repayment Worksheets for Buybacks in 2018
(English, PDF 326.22 KB)
Open PDF file, 388.56 KB,
Repayment Worksheets for Buybacks in 2017
(English, PDF 388.56 KB)
RFP Notice Guidance
Open PDF file, 49.99 KB,
Initial RFP Evaluation
(English, PDF 49.99 KB)
Open PDF file, 64.82 KB,
PERAC Legal RFP Notice Sample
(English, PDF 64.82 KB)
Open PDF file, 152 KB,
PERAC RFP for Legal Services Sample
(English, PDF 152 KB)
PROSPER Forms
Open PDF file, 256.33 KB,
PROSPER Individual Account Approval Form
(English, PDF 256.33 KB)
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