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Counseling Center
1111 East Main Street
Richmond, VA 23219
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Administrative Offices
1200 East Main Street
Richmond, VA 23219

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 > Forms


employer Retirement Forms
Form #DescriptionLast
ALL Hybrid Forms for Employers opens web page
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-3ORP Request for Transfer of Funds to ORP 03/2017 opens pdf 321kb
VRS-5 Application for Retirement 01/2016 opens pdf 314kb
VRS-6 Application for Disability Retirement 10/2015 opens pdf 344kb
VRS-6A Explanation of Disability 12/2012 opens pdf 156kb
VRS-6B Physician's Report 08/2016 opens pdf 194kb
VRS-6C Request for Estimate of Disability Retirement Benefits 02/2011 opens pdf 33kb
VRS-6D Employer Information for Disability Application 02/2011 opens pdf 26kb
VRS-6E Certification of Alternate Employment for Disability Retiree for Political Subdivision Hazardous Duty Employees 08/2012 opens pdf 264kb
VRS-7ORP Notice of Return to Covered Employment Optional Retirement Plan Retiree 11/2012 opens pdf 217kb
VRS-8 Certification of Exception from General Early Retirement Provisions 07/2013 opens pdf 246kb
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-49 Change to Certification for Retirement 02/2011 opens pdf 29kb
VRS-57 Authorization for Direct Deposit of Monthly Benefit 12/2017 opens pdf 222kb
VRS-65B Certification of Eligibility to Participate in Optional Retirement Plan for Political Appointees 02/2011 opens pdf 30kb
VRS-65D Termination Certification Form- Optional Retirement Plan for Higher Education 01/2017 opens pdf 303kb
VRS-65E Termination Certification Form - Optional Retirement Plan for Political Appointees 01/2017 opens pdf 236kb
VRS-71B Termination Certification Form - Optional Retirement Plan for School Superintendents 01/2017 opens pdf 303kb
VRS-75 Optional Retirement Plan Health Insurance Credit Employer Certification of Service
Completed only by employers certifying Optional Retirement Plan participants.
01/2017 opens pdf 211kb
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 07/2016 opens pdf 151kb
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