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
Accidental Disability Retirement Checklist, Open PDF file, 85.8 KB
(English, PDF 85.8 KB)
Disability Retirement Application, Open PDF file, 445.85 KB
(English, PDF 445.85 KB)
Disability Transmittal to the Commission, Open PDF file, 242.79 KB
(English, PDF 242.79 KB)
Notice of Retirement Board Action on Disability Application, Open PDF file, 73.17 KB
(English, PDF 73.17 KB)
Notice to PERAC of Reinstatement of Duties, Open PDF file, 251.5 KB
(English, PDF 251.5 KB)
General Membership Forms for Administrators
Notice to PERAC of the Granting of 12(2)(d) Benefits, Open PDF file, 75.2 KB
(English, PDF 75.2 KB)
Termination Retirement Transmittal, Open PDF file, 81.26 KB
(English, PDF 81.26 KB)
Compliance Forms for Administrators & Retirement Board Members
Board Change Form, Open PDF file, 567.74 KB
(English, PDF 567.74 KB)
PROSPER Individual Account Approval Application, Open PDF file, 510.91 KB
(English, PDF 510.91 KB)
Employer Forms
Employer's Request for Information, Open PDF file, 61.28 KB
(English, PDF 61.28 KB)
Employer's Shift Substitution Certification, Open PDF file, 250.28 KB
(English, PDF 250.28 KB)
Employer's Termination Retirement Certification, Open PDF file, 59.48 KB
(English, PDF 59.48 KB)
Employer Statement for Disability Retirement Application, Open PDF file, 368.29 KB
(English, PDF 368.29 KB)
Involuntary Retirement Application, Open PDF file, 421.97 KB
(English, PDF 421.97 KB)
Buyback Worksheets
Repayment Worksheets for Buybacks in 2026, Open XLSX file, 17.21 MB
(English, XLSX 17.21 MB)
Repayment Worksheets for Buybacks in 2025, Open PDF file, 1.13 MB
(English, PDF 1.13 MB)
Repayment Worksheets for Buybacks in 2024, Open PDF file, 524.24 KB
(English, PDF 524.24 KB)
Repayment Worksheets for Buybacks in 2023, Open PDF file, 159.01 KB
(English, PDF 159.01 KB)
Repayment Worksheets for Buybacks in 2022, Open XLSX file, 17.17 MB
(English, XLSX 17.17 MB)
RFP Notice Guidance
Initial RFP Evaluation, Open PDF file, 49.99 KB
(English, PDF 49.99 KB)
PERAC Legal RFP Notice Sample, Open PDF file, 64.82 KB
(English, PDF 64.82 KB)
PERAC RFP for Legal Services Sample, Open PDF file, 152 KB
(English, PDF 152 KB)
PROSPER Forms
PROSPER Individual Account Approval Form, Open PDF file, 510.91 KB
(English, PDF 510.91 KB)
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