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 call or email to alert VRS of its pending arrival. VRS does not accept forms via email, which is not a secure form of communication.

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

Forms
Displays a list of available VRS publications in a table. Most publications are in Adobe PDF format and can be downloaded. When the form is not available on our server, we'll link to another website.
Form # Title/Description Last Updated Download/Link
N/A Approved Domestic Relations Orders - Defined Benefit Plan 08-2019
N/A Approved Domestic Relations Orders - Defined Contribution Account(s) 08-2019
ALL All Hybrid Retirement Plan Forms N/A
ALL Securian Financial/VRS Life Insurance Forms
VRS-31, VRS-32, VRS-35, VRS-37, VRS-38, VRS-39, VRS-39A, VRS-39R and VRS Certificate of Life Insurance.
N/A
IRS 402(F) IRS 402(f) - Special Tax Notice - VRS Defined Benefit Plans
Before taking a refund, read this notice, which explains the tax consequences of taking a refund versus direct rollover into another plan.
10-2020
T-20879 State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants 03-2020
VSDP-2 College and University Opt-Out Form 09-2011
VRS-2 Designation of Beneficiary
VRS members and retirees now update beneficiaries online through their secure myVRS account.
07-2021
VRS-2A Designation of Beneficiary - Continuation
VRS members and retirees now update beneficiaries online through their secure myVRS account.
02-2020
VRS-3A Name and Address Declaration For Deferred Members 02-2011
VRS-3ORP Request for Transfer of Funds to ORP 07-2019
VRS-5 Application for Service Retirement
Before completing the form, log in to myVRS for retirement counseling resources and review the Apply for Retirement page to determine if you can retire online.
09-2021
VRS-6 Application for Disability Retirement 05-2020
VRS-6A Explanation of Disability 01-2019
VRS-6B Physician's Report 01-2019
VRS-6C Request for Estimate of Disability Retirement Benefits 02-2011
VRS-6D Employer Information for Disability Application 10-2020
VRS-6E Certification of Alternate Employment for Disability Retiree for Political Subdivision Hazardous Duty Employees 08-2012
VRS-7ORP Notice of Return to Covered Employment Optional Retirement Plan Retiree 11-2012
VRS-8 Certification of Exception from General Early Retirement Provisions 07-2013
VRS-11 Employer Certification of Involuntary Separation Under the Workforce Transition Act 02-2016
VRS-11A Employer Certification of Basic Group Life Insurance Coverage Under Workforce Transition Act 02-2011
VRS-11B Employer Certification of Involuntary Separation Under the Transitional Benefits Program 06-2015
VRS-11C Employer Certification of VRS Basic Group Life Insurance Coverage Under the Transitional Benefits Program 02-2011
VRS-15 Request for Income Tax Withholding 08-2020
VRS-26 Application for Purchase of Prior Service Credit 08-2017
VRS-26C Authorization for After-Tax Payroll Deduction to Purchase Service Credit
VRS members now select payment agreement type in myVRS and provide confirmation details page to employer.
N/A  
VRS-26E Agreement for Pretax Salary Reduction to Purchase Service Credit
VRS members now select payment agreement type in myVRS and provide confirmation details page to employer.
N/A  
VRS-45 Request for Health Insurance Credit
Retirees can update health insurance policy information online through myVRS.
07-2021
VRS-48 Request for Member Information Change 03-2013
VRS-57 Authorization for Direct Deposit of Monthly Benefit
Retirees can update direct deposit information online through myVRS.
06-2021
VRS-58 Name and Address Declaration
Just changing your address? Make the update using myVRS for quicker processing.
07-2021
VRS-61 Notification of Electronic Payment Information 09-2021
VRS-65D Termination Certification Form- Optional Retirement Plan for Higher Education 09-2021
VRS-65E Termination Certification Form - Optional Retirement Plan for Political Appointees 09-2020
VRS-67A Authorization of Administrative Contacts 05-2021
VRS-70 Request for Review of Membership Records 02-2011
VRS-71B Termination Certification Form - Optional Retirement Plan for School Superintendents 09-2020
VRS-75 Optional Retirement Plan Health Insurance Credit Employer Certification of Service
Completed by Optional Retirement Plan participants and by their employers, who certify employment.
12-2020
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.
07-2021
VRS-77 Certification of Hazardous Duty 04-2021
VRS-78 Authorization to Deduct Insurance Premiums
Completed only by employers for non-state participants.
07-2021
VRS-83 Certification of Eligibility to Participate in Virginia Supplemental Retirement Plan 01-2009
VRS-160 Certification of Eligibility for Critical Shortage Teachers and Administrators 07-2020
VRS-160C Certification of Eligibility for Retiree School Security Officers 07-2020
VRS-160D Certification of Eligibility for Critical Shortage Bus Drivers 07-2020
VRS-170 Authorization of Coverage Retention for the Long Term Care Plan (VSDP or VLDP) 01-2014
VRS-171 Protection Against Unintentional Lapse of Long Term Care (VSDP or VLDP) 01-2014
VRS-180 Employer Request for Forfeiture of Member Benefits 12-2015
VRS-900 Authorization to Discuss VRS Account Information 02-2011
VRS-901 VRS Durable Power of Attorney 01-2021