VRS Logo Friday, November 20, 2009

Virginia Retirement System
1200 East Main Street
P.O. Box 2500
Richmond, VA 23218-2500
1-888-827-3847

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Retiree Forms

retiree Forms
Form #DescriptionLast
Updated
Non-fillFillable graphic:help with fillable pdf forms
N/A Minnesota Life/VRS Life Insurance Forms Page opens web page 
N/A VRS Certificate of Life Insurance opens pdf 322kb 
T-20637 State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants opens pdf 88kb 
VRS-2 Designation of Beneficiary
To designate more than 4 beneficiaries, a continuation form, the VRS-2A, is also required.
07/2009 opens pdf 42kb opens fillable pdf 169kb
VRS-2A Designation of Beneficiary - Continuation 07/2009 opens pdf 30kb opens fillable pdf 153kb
VRS-7 Request for Termination of Monthly Benefit 07/2004 opens pdf 32kb opens fillable pdf 176kb
VRS-15 Request for Income Tax Withholding 07/2005 opens pdf 61kb opens fillable pdf 164kb
VRS-45 Request for Health Insurance Credit
Retired participants who do not have premiums deducted from their VRS monthly benefit must complete this form.
11/2008 opens pdf 70kb opens fillable pdf 178kb
VRS-57 Authorization for Direct Deposit of Monthly Benefit 07/2008 opens pdf 27kb opens fillable pdf 144kb
VRS-58 Name/Address Declaration For Retirees 12/2007 opens pdf 28kb opens fillable pdf 34kb
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.
11/2008 opens pdf 34kb opens fillable pdf 73kb
VRS-160 Certification of Eligibility for Critical Shortage Teachers and Administrators 10/2008 opens pdf 34kb opens fillable pdf 155kb
VRS-900 Authorization to Discuss VRS Account Information 04/2009 opens pdf 31kb opens fillable pdf 145kb
VRS-901 VRS Durable Power of Attorney 04/2009 opens pdf 60kb opens fillable pdf 168kb
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