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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.
| Form # | Description | Last Updated | Download |
|---|---|---|---|
| N/A | Approved Domestic Relations Order - Defined Benefit Plan | 08/2019 |  702kb |
| N/A | Approved Domestic Relations Order - Defined Contribution Account(s) | 08/2019 | 934kb |
| ALL | Hybrid Forms for Members |  | |
| ALL | Hybrid Forms for Employers | | |
| 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. |
| |
| 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. |
12/2018 | 141kb |
| T-20879 | State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants | 03/2019 | 588kb |
| VSDP-2 | College and University Opt-Out Form | 09/2011 | 146kb |
| VRS-2 | Designation of Beneficiary To designate more than 3 beneficiaries, a continuation form, the VRS-2A, is also required. |
09/2019 | 180kb |
| VRS-2A | Designation of Beneficiary - Continuation | 09/2019 | 148kb |
| VRS-3A | Name and Address Declaration For Deferred Members | 02/2011 | 28kb |
| VRS-3ORP | Request for Transfer of Funds to ORP | 07/2019 | 320kb |
| VRS-5 | Application for Service Retirement | 08/2019 | 502kb |
| VRS-6 | Application for Disability Retirement | 04/2019 | 557kb |
| VRS-6A | Explanation of Disability | 01/2019 | 321kb |
| VRS-6B | Physician's Report | 01/2019 | 344kb |
| VRS-6C | Request for Estimate of Disability Retirement Benefits | 02/2011 | 33kb |
| VRS-6D | Employer Information for Disability Application | 04/2019 | 26kb |
| VRS-6E | Certification of Alternate Employment for Disability Retiree for Political Subdivision Hazardous Duty Employees | 08/2012 | 264kb |
| VRS-7ORP | Notice of Return to Covered Employment Optional Retirement Plan Retiree | 11/2012 | 217kb |
| VRS-8 | Certification of Exception from General Early Retirement Provisions | 07/2013 | 246kb |
| VRS-11 | Employer Certification of Involuntary Separation Under the Workforce Transition Act | 02/2016 | 389kb |
| VRS-11A | Employer Certification of Basic Group Life Insurance Coverage Under Workforce Transition Act | 02/2011 | 29kb |
| VRS-11B | Employer Certification of Involuntary Separation Under the Transitional Benefits Program | 06/2015 | 235kb |
| VRS-11C | Employer Certification of VRS Basic Group Life Insurance Coverage Under the Transitional Benefits Program | 02/2011 | 29kb |
| VRS-15 | Request for Income Tax Withholding | 10/2018 | 114kb |
| VRS-26 | Application for Purchase of Prior Service Credit | 08/2017 | 314kb |
| 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. |
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| VRS-26E | Agreement for Pre-Tax Salary Reduction to Purchase Service Credit VRS members now select payment agreement type in myVRS and provide confirmation details page to employer. |
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| 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 | 423kb |
| VRS-48 | Request for Member Information Change | 03/2013 | 219kb |
| VRS-49 | Change to Certification for Retirement This form is no longer required. Employers make certification changes directly in myVRS Navigator. |
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| VRS-57 | Authorization for Direct Deposit of Monthly Benefit | 08/2019 | 199kb |
| VRS-58 | Name and Address Declaration For Retirees | 03/2013 | 252kb |
| VRS-61 | Notification of Electronic Payment Information | 03/2018 | 266kb |
| VRS-65D | Termination Certification Form- Optional Retirement Plan for Higher Education | 01/2017 | 303kb |
| VRS-65E | Termination Certification Form - Optional Retirement Plan for Political Appointees | 01/2017 | 236kb |
| VRS-67A | Authorization of Administrative Contacts | 01/2013 | 54kb |
| VRS-70 | Request for Review of Membership Records | 02/2011 | 29kb |
| VRS-71B | Termination Certification Form - Optional Retirement Plan for School Superintendents | 01/2017 | 303kb |
| 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. |
04/2019 | 211kb |
| 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. |
04/2019 | 273kb |
| VRS-77 | Certification of Hazardous Duty | 02/2011 | 24kb |
| VRS-78 | Authorization to Deduct Insurance Premiums Completed only by employers for non-state participants. |
04/2019 | 151kb |
| VRS-83 | Certification of Eligibility to Participate in Virginia Supplemental Retirement Plan | 01/2009 | 99kb |
| VRS-160 | Certification of Eligibility for Critical Shortage Teachers and Administrators | 04/2010 | 254kb |
| VRS-160A | Certification of Non-Participation of Critical Shortage Teachers and Administrators | 04/2013 | 144kb |
| VRS-170 | Authorization of Coverage Retention for the Long Term Care Plan (VSDP or VLDP) | 01/2014 | 130kb |
| VRS-171 | Protection Against Unintentional Lapse of Long Term Care (VSDP or VLDP) | 01/2014 | 126kb |
| VRS-180 | Employer Request for Forfeiture of Member Benefits | 12/2015 | 88kb |
| VRS-900 | Authorization to Discuss VRS Account Information | 02/2011 | 33kb |
| VRS-901 | VRS Durable Power of Attorney | 07/2016 | 151kb |
