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VRS Logo Sunday, October 13, 2019

Counseling Center
1111 East Main Street
Richmond, VA 23219
8:30 a.m.–4:00 p.m.
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Administrative Offices
1200 East Main Street
Richmond, VA 23219

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All forms are fillable and ready for download and printing. VRS accepts all forms by mail or fax. Fax to: 804-786-9718. If on deadline when faxing a form, please contact VRS to alert us of its pending arrival.

Note: VRS does not accept forms via email, which is not a secure form of communication.

employer Service Retirement Forms
Form #DescriptionLast
T-20879 State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants 03/2019 opens pdf 588kb
VRS-2 Designation of Beneficiary
To designate more than 3 beneficiaries, a continuation form, the VRS-2A, is also required.
09/2019 opens pdf 180kb
VRS-2A Designation of Beneficiary - Continuation 09/2019 opens pdf 148kb
VRS-5 Application for Service Retirement 08/2019 opens pdf 502kb
VRS-8 Certification of Exception from General Early Retirement Provisions 07/2013 opens pdf 246kb
VRS-15 Request for Income Tax Withholding 10/2018 opens pdf 114kb
VRS-45 Request for Health Insurance Credit
Retired participants who do not have premiums deducted from their VRS monthly benefit must complete this form.
04/2019 opens pdf 423kb
VRS-49 Change to Certification for Retirement
This form is no longer required. Employers make certification changes directly in myVRS Navigator.
VRS-57 Authorization for Direct Deposit of Monthly Benefit 08/2019 opens pdf 199kb
VRS-77 Certification of Hazardous Duty 02/2011 opens pdf 24kb
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 10/2019 opens pdf 375kb
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