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Non-fillFillable graphic:help with fillable pdf forms
Hybrid Forms for Members opens web page 
Hybrid Forms for Employers opens web page 
N/A Minnesota Life/VRS Life Insurance Forms Page opens web page 
N/A VRS Certificate of Life Insurance 07/2009 opens pdf 173kb 
T-20879 State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants 7/2013 opens pdf 98kb 
VSDP-2 College and University Opt-Out Form 09/2011 opens pdf 22kb opens fillable pdf 146kb
VRS-2 Designation of Beneficiary
To designate more than 3 beneficiaries, a continuation form, the VRS-2A, is also required.
01/2014 opens pdf 52kb opens fillable pdf 180kb
VRS-2A Designation of Beneficiary - Continuation 01/2014 opens pdf 29kb opens fillable pdf 49kb
VRS-3 Defined Benefit Plan Request for Refund
You MUST read the IRS 402(f) Special Tax Notice pdf icon before filling out this form.
01/2014 opens pdf 49kb opens fillable pdf 174kb
VRS-3A Name and Address Declaration For Deferred Members 02/2011 opens pdf 22kb opens fillable pdf 28kb
VRS-3ORP Request for Plan-to-Plan Transfer to ORP 02/2011 opens pdf 24kb opens fillable pdf 33kb
VRS-3S Signature Authorization Member Contribution Refund 11/2012 opens pdf 37kb opens fillable pdf 142kb
VRS-5 Application for Retirement 12/2012 opens pdf 58kb opens fillable pdf 227kb
VRS-6 Application for Disability Retirement 12/2012 opens pdf 58kb opens fillable pdf 236kb
VRS-6A Explanation of Disability 12/2012 opens pdf 27kb opens fillable pdf 156kb
VRS-6B Physician's Report 02/2011 opens pdf 31kb opens fillable pdf 93kb
VRS-6C Request for Estimate of Disability Retirement Benefits 02/2011 opens pdf 23kb opens fillable pdf 33kb
VRS-6D Employer Information for Disability Application 02/2011 opens pdf 21kb opens fillable pdf 26kb
VRS-6E Certification of Alternate Employment for Disability Retiree for Political Subdivision Hazardous Duty Employees 08/2012 opens pdf 57kb opens fillable pdf 264kb
VRS-7ORP Notice of Return to Covered Employment Optional Retirement Plan Retiree 11/2012 opens pdf 40kb opens fillable pdf 217kb
VRS-8 Certification of Exception from General Early Retirement Provisions 07/2013 opens pdf 41kb opens fillable pdf 246kb
VRS-11 Employer Certification of Involuntary Separation Under the Workforce Transition Act 07/2014 opens pdf 34kb opens fillable pdf 43kb
VRS-11A Employer Certification of Basic Group Life Insurance Coverage Under Workforce Transition Act 02/2011 opens pdf 27kb opens fillable pdf 29kb
VRS-11B Employer Certification of Involuntary Separation Under the Transitional Benefits Program 02/2011 opens pdf 33kb opens fillable pdf 38kb
VRS-11C Employer Certification of VRS Basic Group Life Insurance Coverage Under the Transitional Benefits Program 02/2011 opens pdf 27kb opens fillable pdf 29kb
VRS-15 Request for Income Tax Withholding 02/2011 opens pdf 30kb opens fillable pdf 45kb
VRS-26 Application for Purchase of Prior Service Credit 11/2013 opens pdf 40kb opens fillable pdf 170kb
VRS-26C Authorization for After-Tax Payroll Deduction to Purchase Service Credit 03/2013 opens pdf 33kb opens fillable pdf 210kb
VRS-26E Agreement for Pre-Tax Salary Reduction to Purchase Service Credit 03/2013 opens pdf 27kb opens fillable pdf 147kb
VRS-27 Waiver of Life Insurance Coverage 02/2011 opens pdf 21kb opens fillable pdf 23kb
VRS-31 Accidental Dismemberment and Loss of Sight 12/2010  opens fillable pdf 386kb
VRS-32 Group Life Evidence of Insurability 01/2011  opens fillable pdf 344kb
VRS-35E Conversion of Group Life Insurance Enrollment 09/2013  opens fillable pdf 712kb
VRS-37 Absolute Assignment of Group Life Insurance 02/2011  opens fillable pdf 314kb
VRS-38 Assignees Change of Beneficiary 01/2011  opens fillable pdf 352kb
VRS-39 Application for Optional Life Insurance 01/2011  opens fillable pdf 325kb
VRS-39A Request for Change Under Optional Group Life Insurance Plan 02/2011  opens fillable pdf 334kb
VRS-39R Retiree Optional Life Continuation 08/2013  opens fillable pdf 299kb
VRS-45 Request for Health Insurance Credit
Retired participants who do not have premiums deducted from their VRS monthly benefit must complete this form.
11/2013 opens pdf 63kb opens fillable pdf 191kb
VRS-48 Request for Member Information Change 03/2013 opens pdf 43kb opens fillable pdf 219kb
VRS-49 Change to Certification for Retirement 02/2011 opens pdf 22kb opens fillable pdf 29kb
VRS-57 Authorization for Direct Deposit of Monthly Benefit 02/2011 opens pdf 22kb opens fillable pdf 31kb
VRS-58 Name and Address Declaration For Retirees 03/2013 opens pdf 40kb opens fillable pdf 252kb
VRS-60 Request for Estimate of Retirement Benefits 03/2013 opens pdf 50kb opens fillable pdf 167kb
VRS-61 Notification of Electronic Payment Information 12/2012 opens pdf 37kb opens fillable pdf 157kb
VRS-65 Election to Participate - Optional Retirement Plan for Higher Education 03/2014 opens pdf 37kb opens fillable pdf 243kb
VRS-65B Certification of Eligibility to Participate in Optional Retirement Plan for Political Appointees 02/2011 opens pdf 23kb opens fillable pdf 30kb
VRS-65D Termination Certification Form- Optional Retirement Plan for Higher Education 04/2013 opens pdf 75kb opens fillable pdf 238kb
VRS-65E Termination Certification Form - Optional Retirement Plan for Political Appointees 04/2013 opens pdf 77kb opens fillable pdf 172kb
VRS-67A Authorization of Administrative Contacts 01/2013 opens pdf 36kb opens fillable pdf 54kb
VRS-70 Request for Review of Membership Records 02/2011 opens pdf 21kb opens fillable pdf 29kb
VRS-71B Termination Certification Form - Optional Retirement Plan for School Superintendents 04/2013 opens pdf 74kb opens fillable pdf 239kb
VRS-75 Optional Retirement Plan Health Insurance Credit Employer Certification of Service
Completed only by employers certifying Optional Retirement Plan participants.
07/2013 opens pdf 36kb opens fillable pdf 168kb
VRS-76 Certification of Employment for Health Insurance Credit Eligibility
Completed only by employers certifying general registrars, local officers, employees of these referenced positions and local social service employees.
11/2013 opens pdf 36kb opens fillable pdf 172kb
VRS-77 Certification of Hazardous Duty 02/2011 opens pdf 22kb opens fillable pdf 24kb
VRS-78 Authorization to Deduct Insurance Premiums and Application for Health Insurance Credit
Completed only by employers for non-state participants.
07/2013 opens pdf 30kb opens fillable pdf 151kb
VRS-83 Certification of Eligibility to Participate in Virginia Supplemental Retirement Plan 01/2009 opens pdf 23kb opens fillable pdf 99kb
VRS-160A Certification of Non-Participation of Critical Shortage Teachers and Administrators 04/2013 opens pdf 26kb opens fillable pdf 144kb
VRS-170 Authorization of Coverage Retention for the Long Term Care Plan (VSDP or VLDP) 01/2014 opens pdf 21kb opens fillable pdf 130kb
VRS-171 Protection Against Unintentional Lapse of Long Term Care (VSDP or VLDP) 01/2014 opens pdf 20kb opens fillable pdf 126kb
VRS-180 Employer Request for Forfeiture of Member Benefits 12/2011 opens pdf 36kb opens fillable pdf 166kb
VRS-900 Authorization to Discuss VRS Account Information 02/2011 opens pdf 28kb opens fillable pdf 33kb
VRS-901 VRS Durable Power of Attorney 06/2014 opens pdf 43kb opens fillable pdf 47kb
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