Retiree Forms

retiree Forms
Form #	Description	Last Updated	Non-fill	Fillable
N/A	Minnesota Life/VRS Life Insurance Forms Page
N/A	VRS Certificate of Life Insurance		322kb
T-20637	State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants		88kb
VRS-2	Designation of Beneficiary To designate more than 4 beneficiaries, a continuation form, the VRS-2A, is also required.	07/2009	42kb	169kb
VRS-2A	Designation of Beneficiary - Continuation	07/2009	30kb	153kb
VRS-7	Request for Termination of Monthly Benefit	07/2004	32kb	176kb
VRS-15	Request for Income Tax Withholding	07/2005	61kb	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	70kb	178kb
VRS-57	Authorization for Direct Deposit of Monthly Benefit	07/2008	27kb	144kb
VRS-58	Name/Address Declaration For Retirees	12/2007	28kb	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	34kb	73kb
VRS-160	Certification of Eligibility for Critical Shortage Teachers and Administrators	10/2008	34kb	155kb
VRS-900	Authorization to Discuss VRS Account Information	04/2009	31kb	145kb
VRS-901	VRS Durable Power of Attorney	04/2009	60kb	168kb