Retirement and Benefits Forms Alpha List
For additional help with fill-in forms, contact the Communications section at (800) 821-2251 or in Juneau (907) 465-4460.
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A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, R, S, T, U, V, W, X, Y, Z
A
- Active and Deferred Members Beneficiary Designation (02-822_ [PDF 96K]
- Active Welcome Pack, AlaskaCare [PDF]
- Address Changes web page
- Address Change Card for Retirees and Deferred (02-824a) [PDF 62K]
- Alaska Cost-of-Living Allowance Affidavit of Residency (gen020) [PDF 97K]
- Alaska Cost-of-Living Allowance (COLA) Brochure (gen050)[PDF 325K]
- Alaska Cost-of-Living Allowance Evidence of Residency Requirements (gen019) [PDF 103K]
- Alaska Cost-of-Living Allowance Return to Alaska Notification (02-1896a) [PDF 165K]
- AlaskaCare Authorization for the Use and/or Disclosure of PHI (ben043) [PDF 124K]
- AlaskaCare Employee Health Claim Appeal (ben075) brochure [PDF 92K]
- AlaskaCare Claim Forms web page
- AlaskaCare Employee Health Coverage Continuation brochure web page
- AlaskaCare Enrollment Packet web page
- AlaskaCare Federal Family Leave Health Continuation Health Premium Payment (ben030) [PDF 104K]
- AlaskaCare Information Booklet [PDF
- AlaskaCare Important Tax Implications for Enrollment of Same-sex Partner flyer [PDF]
- AlaskaCare Notice of Privacy Practice web page
- AlaskaCare Premiums
- AlaskaCare Retiree Health Claim Appeal brochure (ben074) [PDF 92K]
- AlaskaCare Retiree Health Coverage Continuation web page
- AlaskaCare Student Status Verification [PDF 75K]
- Application for Alaska Cost-of-Living Allowance (02-1896) [PDF 266K]
- Application for PERS Retirement Benefits web page
- Application for TRS Retirement Benefits web page
- Authorization for Release of Information (ben021) [PDF 23K]
B
- Basic and Select Life Insurance Enrollment or Change Form (5-301a) (Active) [PDF 137K]
- Beneficiary Designation (Active and Deferred Members) (02-822) [PDF 96K]
- Beneficiary Designation (Retiree) (02-822a) [PDF 108K]
- Beneficiary Forms (all systems) web page
C
- Calls to Active Military Duty - PERS flyer [PDF]
- Calls to Active Military Duty - TRS flyer [PDF]
- Certification of Vocational Rehabilitation (pers045) [PDF 208K]
- Claimed Service (PERS Application for Military Service Credit) (02-1895) [PDF 72K]
- COLA Brochure (gen050) [PDF]
- COLA Forms web page
- Coordination of Benefits web page
D
- Death Benefits Brochure (PERS) web page | (TRS) web page
- DCP Distribution/Direct Rollover Request [PDF 202K]
- DCR Distribution/Direct Rollover Request "PERS"[PDF 202K]
- DCR Distribution/Direct Rollover Request "TRS" [PDF 202K]
- DCR Plan Elected Official Participation/Waiver (dcr006) [PDF 48K]
- DCR Plan Incoming Direct Rollover
- DCR Plan PERS [PDF 162K] | TRS Beneficiary Designation [PDF 162K]
- Declaration of Tax Status, AlaskaCare (ben069) [PDF 39K]
- Declaration of Tax Status, Retirement Benefits (gen039) [PDF 192K]
- Deferred Compensation Plan Forms web page
- Deferred Compensation Plan Periodic Payments
- Dependent Care Assistance Plan web page
- Dependent Care Assistance Plan Questions and Answers web page
- Dependent Care Assistance Plan Payroll Deduction Estimating Worksheet (ben003) [PDF 73K]
- Dependent Care Assistance Plan Request for Reimbursement [PDF 205K]
- Direct Deposit Authorization for Retirees (02-1900r) [PDF 191K]
- Disability Insurance for Optional Benefits and AlaskaCare web page
- Distribution/Direct Rollover Request Election (DCR Plan)
- Divorce or Dissolution brochure web page
E
- Election of Standard or Alternate Option (pers004) — PERS Noncertificated (Classified) School Employees [PDF 49K]
- Electronic Direct Deposit Authorization for Retirees (02-1900r) [PDF 181K]
- Employee's Withholding Allowance Certificate (W-4P) (for Deferred Compensation only) [PDF 43K]
- Employer Services - LogonID Request (gen012-Political Subdivisions) [PDF 284K]
- Employer Services - LogonID Request (gen012-State) PDF 42K]
- Employer Representative/administrator Signature Card - Employer Services (gen030) [PDF 319K]
- Enrollment Packet (AlaskaCare, Optional Benefits) web page
- Evidence of Birthdate (02-823) [PDF 43K]
- Evidence of Birthdate for Spouse (02-823a) [PDF 60K]
H
- Hardship Waiver (PERS/TRS) (gen010) [PDF 71K]
- Health Benefits Enrollment/Waiver Form for Retirees or Benefit Recipients (pre-1986) (ben051) (Tier I) [PDF 46K]
- Health Benefits Enrollment/Waiver Form for Retirees or Benefit Recipients (post-1986) (ben035) (Tier II & III with system-paid medical) [PDF 84K]
- Health Coverage Continuation - AlaskaCare Employee Health Plan web page
- Health Coverage Continuation - AlaskaCare Retiree Health Plan web page
- Health Dependent Change (02-1854r) (Retiree) [PDF 106K]
- Health Flexible Spending Account (HFSA) web page
- HFSA Claim form [PDF 119K]
- HFSA Direct Deposit Form [PDF 89K]
- HFSA Reimbursement for OTC Drugs [PDF 108K]
I
- Insurance Benefits flyer (Retirees hired before 7/1/86-PERS, 7/1/90-TRS) [PDF]
- Insurance Benefits flyers (Retirees hired after 6/30/86-PERS, 6/30/90-TRS) [PDF]
L
- Leaving State Employment (pers024) brochure (PERS) [PDF 254K]
- Leaving State Employment (trs012) brochure (TRS) [PDF 233K]
- Life Insurance
- Basic and Select Life Insurance Enrollment or Change (5-301a) (Active) [PDF 137K]
- Life Insurance Brochure web page
- Optional Benefits Beneficiary (02-1841) (Life, AD&D, Survivor) [PDF 49K]
- Political Subdivision Beneficiary Designation (ben013) (Life, AD&D, Survivor) [PDF 55K]
- Retirees Optional Life Insurance Continuation/Waiver (02-1858) [PDF 127K]
- Long-Term Care Plan Booklet (bronze option) [PDF]
- Long-Term Care Plan Booklet (silver, gold, platinum option) [PDF]
- Long-Term Care Plan Health Questionnaire (ben065) [PDF 143K]
- LogonID Request - Employer Services (gen012-Political Subdivision) [PDF 284K]
- LogonID Request - Employer Services (gen012-State) [PDF 42K]
- Lump Sum Death Benefit Application (02-1806a) [PDF 69K]
- Lump Sum Death Benefit Application (02-1806b) (Survivor)[PDF 66K]
M
- Managed Account Election [PDF]
- Medicare and the AlaskaCare Retiree Health Plan (ben076) brochure [PDF 482K]
- Military Duty--JRS Call to Active Military Duty flyer [PDF]
- Military Duty--PERS Call to Active Military Duty flyer [PDF]
- Military Duty--TRS Call to Active Military Duty flyer [PDF]
- Military Service Credit web page
- Military Service Credit Application (02-1895) (PERS) [PDF 72K]
- Military Service Credit Application (02-830) (TRS) [PDF 61K]
N
- Name Change Notice (Retiree) (gen047) [PDF 98K]
- National Guard and Naval Militia Retirement System (02-1890) Application [PDF 237K]
- Notice of Privacy Practice web page
O
- Optional Benefits and Disability Insurance web page
- Optional Benefits Dependent Care Assistance Plan Request for Reimbursement [PDF 205K]
- Optional Benefits Enrollment Packet web page
- Optional Benefits Political Subdivision Beneficiary Designation (ben013) (Life, AD&D, Survivor) [PDF 55K]
- Other Health Insurance Verification Form (AlaskaCare) [PDF]
P
- PERS / TRS Defined Benefit Refund Election (gen008) [PDF 142K]
- (PERS Tiers I, II, III / TRS Tiers I, II)
- PERS DCR Plan Beneficiary Designation [PDF 162K]
- (PERS Tier IV)
- PERS DCR Plan Distribution/Direct Rollover Request [PDF 202K]
- (PERS Tier IV)
- PERS Alternate Option Verification of Service (pers021) [PDF 304K]
- PERS Application for Alaska Bureau of Indian Affairs Service (pers016) [PDF 336K]
- PERS Application for Military Service Credit (02-1895) [PDF 72K]
- PERS Application for Retirement Benefits web page
- PERS Certification of Vocational Rehabilitation (pers045) [PDF 208K]
- PERS Death Benefits web page
- PERS Elected Official Participation/Waiver (02-1832) [PDF 38K]
- PERS Election of Standard or Alternate Option (pers004)—Noncertificated (Classified) School Employees [PDF 38K]
- PERS Employee Demographics (02-1861) [PDF 33K]
- PERS Guidelines to Apply for Retirement brochure [PDF]
- PERS Information Handbook web page
- PERS Leaving State Employment (pers024) brochure [PDF 187K]
- PERS Military Service Credit web page
- PERS Minimum Requirements for Retirement and Service Credit [PDF]
- PERS Nonoccupational Disability Benefits web page
- PERS Occupational Disability Benefits web page
- PERS Participation Agreement Amendment [PDF 10K]
- PERS Prior Peace Officer Service Verification Claim (pers033) [PDF 41K]
- PERS Reemployment of Disabled Employees Statutes [PDF]
- PERS Rights of Spouses and Dependents [PDF]
- PERS Social Security, Medicare, and your PERS Retirement Benefit (gen049) Brochure [PDF 367K]
- PERS Standard Option-Reemployed Retiree (pers018) [PDF 42K]
- PERS Temporary Service Credit brochure [PDF 193K]
- PERS Temporary Service Verification/Claim (02-1882) [PDF 38K]
- PERS Understanding Leave of Absence and Furlough (pers052) [PDF 143K]
- PERS Verification of Part-time Hours and Salaries (pers022) [PDF 74K]
- PERS Verification of Salaries and Service (02-1883) [PDF 68K]
- PERS Village Public Safety Officer Service Verification/Claim (pers002) [PDF 56K]
- PERS Voluntary Employee Savings Plan Beneficiary Designation (pers051) [PDF 120K]
- PERS Voluntary Employee Savings Plan Enrollment, Change, Discontinuation or Withdrawal (pers050) [PDF 99K]
- PERS Voluntary Savings Plan (pers048) brochure [PDF 155K]
- PERS Waiver of Peace Officer/Fire Fighter Coverage (pers034) [PDF 262K]
- PERS Workers' Compensation and LWOP Claim and Verification (pers008) [PDF 288K]
- PERS Working After Retirement web page
- Physician's Certificate (Alaska Cost of Living Allowance) (gen023) [PDF 42K]
- Political Subdivision Beneficiary Designation (ben013) (Life, AD&D, Survivor) [PDF 55K]
- Political Subdivision Enrollment Packet web page
- Premiums web page
Q
R
- Reality Investing web page
- Refund Election
- PERS Tiers I, II, III & TRS Tiers I, II (gen008) [PDF 142K]
- PERS Tier IV & TRS Tier III [PDF 202K]
- Refunding Your Retirement Contributions brochure [PDF 163K]
- Retiree Beneficiary Designation (02-822a) [PDF 108K]
- Retirement Benefits, PERS Application for Retirement Benefits web page
- Retirement Benefits, TRS Application for Retirement Benefits web page
- Retiree Insurance Information Booklet [PDF]
- Retiree Health Claim Appeal (ben074) brochure [PDF]
- Retiree Health Coverage Continuation web page
- Retiree Health Dependent Change (02-1854r) [PDF 106K]
- Retiree Name Change Notice (gen047) [PDF 98K]
- Retiree Welcome Pack (AlaskaCare) [PDF]
- Retiree Important Tax Implications for Enrollment of Same-sex Partner
- Retirement Benefits Election—66-2/3% Last Survivor Option [PDF 36K]
- Retirement Benefits Election—Level Income Option [PDF 12K]
- Retirees Optional Life Insurance Continuation/Waiver (02-1858) [PDF 127K]
S
- SBS-AP Annuity Forms web page
- Same-Sex Partner Affidavit, AlaskaCare (ben068) [PDF 271K]
- Same-Sex Partner Affidavit, Retirement Benefits (gen037) [PDF 249K]
- Same-Sex Partner Beneficiary Forms web page
- Same-Sex Partner Supplement (Tier I) [PDF 231K]
- Same-Sex Partner Supplement (Tier II/III) [PDF 227K]
- Social Security, Medicare, and your PERS/TRS Retirement Benefit (gen049) brochure [PDF 178K]
- Statement Concerning Your Employment in a Job Not Covered by Social Security (SSA-1945) [PDF]
- Student Status Verification, AlaskaCare [PDF 75K]
- Supplemental Annuity Plan Forms web page
- Supplemental Benefits System Beneficiary (02-1841) (Life, AD&D, Survivor) [PDF 49K]
T
- Taxes and Your Benefits (gen025) brochure [PDF 556K]
- TRS Application for Alaska Bureau of Indian Affairs Service (trs003) [PDF 44K]
- TRS Application for Military Service Credit (02-830) [PDF 61K]
- TRS Application for Outside Service Credit (trs031) [PDF 106K]
- TRS Application for Retirement Benefits web page
- TRS Certification of Leave of Absence Without Pay (trs005) [PDF 67K]
- TRS Claim and Verification of Unused Sick Leave Credit (trs021) [PDF 250K]
- TRS Claiming Service Credit brochure [PDF]
- TRS Death Benefits web page
- TRS Defined Contribution Retirement Plan Beneficiary Designation [PDF 162K]
- (TRS Tier III)
- TRS Disability Benefits web page
- TRS Election/Waiver of Supplemental Contributions (trs019) [PDF 57K]
- TRS Guidelines to Apply for Retirement brochure [PDF]
- TRS Information Handbook web page
- TRS Leaving State Employment (trs012) brochure [PDF 134K]
- TRS Military Service Credit web page
- TRS Minimum Requirements for Retirement and Service Credit [PDF]
- TRS/PERS Refund Election
- PERS Tiers I, II, III & TRS Tiers I, II (gen008) [PDF 142K]
- PERS Tier IV [PDF 202K] & TRS Tier III [PDF 202K]
- TRS Rights of Spouses and Dependents [PDF]
- TRS Salary Verification (02-803) [PDF 101K]
- TRS Social Security, Medicare, and your TRS Retirement Benefit (gen049) brochure [PDF 178K]
- TRS Standard Option-Reemployed Retiree (trs009) [PDF 42K]
- TRS Verification of Service (02-808) [PDF 146K]
- TRS Workers' Compensation and LWOP Claim and Verification (trs032) [PDF]
- TRS Working After Retirement web page
V
- Voluntary Employee Savings Plan Beneficiary Designation (pers051) [PDF 120K]
- Voluntary Employee Savings Plan Enrollment, Change, Discontinuation or Withdrawal (pers050) [PDF 99K]
- Voluntary Savings Plan (pers048) brochure [PDF 187K]
- Vision Services Plan (VSP) brochure [PDF 270K]