The following forms were added to the website in February
Beneficiary Forms
- Application for Member Survivor Benefits
- Beneficiary Change Form
- Beneficiary Selection Form
- Beneficiary Selection Form (Option D form) (Option D)
This is a new form! - Notice of Election of Benefits under 12(2)(d)
- Retirement Option Selection Form
- Spousal Affidavit to Determine Benefit Eligibility
Disability Forms
- Disability Retirement Application
- Involuntary Retirement Application
- Authorization to Use or Disclose Protected Health Information
This form is included in the Application for Disability Retirement - Physician's Statement Pertaining to a Member's Disability Retirement Application
- Regional Medical Panel Certificate
This form replaces the three presumptions certificates
A fillable version is available in the PROSPER application
Employer Forms
- Employer's Shift Substitution Certification
- Employer Statement for Disability Retirement Application
General Membership Forms
Additional Resources
Contact for New PERAC Forms
Online
Phone
Main Number
Call Public Employee Retirement Administration Commission, Main Number at (617) 666-4446
Hours: 9:00 a.m. to 5:00 p.m., Monday through Friday
For deaf, hard of hearing, or speech impaired
Fraud Hotline
Call Public Employee Retirement Administration Commission, Fraud Hotline at (800) 445-3266
Call to report suspected pension fraud
Fax
(617) 628-4002