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PERAC Administrator Forms

These forms are used by retirement system staff to process requests to the Public Employee Retirement Administration Commission. 

Online Forms:

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Table of Contents

Disability Forms for Administrators

2016 Annual Statement of Earned Income New Member Data (PDF 410.5 KB)
Accidental Disability Retirement Checklist (PDF 85.8 KB)
Disability Retiree Current Information Form (PDF 207.06 KB)
Disability Retirement Application (PDF 433.55 KB)
Disability Transmittal to the Commission (PDF 242.79 KB)
Notice of Retirement Board Action on Disability Application (PDF 73.17 KB)
Notice to PERAC of Reinstatement of Duties (PDF 245.59 KB)
Physician's Statement Pertaining to a Member's Disability Retirement Application (PDF 276.36 KB)

General Membership Forms for Administrators

Notice to PERAC of the Granting of 12(2)(d) Benefits (PDF 75.2 KB)
Termination Retirement Transmittal (PDF 81.26 KB)

Compliance Forms for Administrators & Retirement Board Members

Board Change Form (PDF 468.17 KB)
PROSPER Individual Account Approval Application (PDF 232.67 KB)

Employer Forms

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)
Involuntary Retirement Application (PDF 311.79 KB)

Buyback Worksheets

Repayment Worksheets for Buybacks in 2020 (PDF 499.88 KB)
Repayment Worksheets for Buybacks in 2019 (PDF 146.18 KB)
Repayment Worksheets for Buybacks in 2018 (PDF 326.22 KB)
Repayment Worksheets for Buybacks in 2017 (PDF 388.56 KB)

RFP Notice Guidance

Initial RFP Evaluation (PDF 49.99 KB)
PERAC Legal RFP Notice Sample (PDF 64.82 KB)
PERAC RFP for Legal Services Sample (PDF 128.75 KB)
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