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Counseling Center
1111 East Main Street
Richmond, VA 23219
8:30 a.m.–4:00 p.m.
Monday–Friday
1-888-827-3847
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Administrative Offices
1200 East Main Street
Richmond, VA 23219

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Forms

member Ready to Retire Forms
Form #DescriptionLast
Updated
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T-20879 State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants 12/2014 opens pdf 68kb
VRS-2 Designation of Beneficiary
To designate more than 3 beneficiaries, a continuation form, the VRS-2A, is also required.
01/2014 opens pdf 180kb
VRS-2A Designation of Beneficiary - Continuation 12/2014 opens pdf 148kb
VRS-5 Application for Retirement 01/2016 opens pdf 314kb
VRS-15 Request for Income Tax Withholding 11/2016 opens pdf 97kb
VRS-45 Request for Health Insurance Credit
Retired participants who do not have premiums deducted from their VRS monthly benefit must complete this form.
11/2016 opens pdf 423kb
VRS-57 Authorization for Direct Deposit of Monthly Benefit 11/2016 opens pdf 81kb
VRS-170 Authorization of Coverage Retention for the Long Term Care Plan (VSDP or VLDP) 01/2014 opens pdf 130kb
VRS-171 Protection Against Unintentional Lapse of Long Term Care (VSDP or VLDP) 01/2014 opens pdf 126kb
VRS-900 Authorization to Discuss VRS Account Information 02/2011 opens pdf 33kb
VRS-901 VRS Durable Power of Attorney 07/2016 opens pdf 151kb
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