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.
|Form #||Title/Description||Last Updated||Download/Link|
|T-20879||State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants||03-2020|
Designation of Beneficiary
To designate more than 3 beneficiaries, a continuation form, the VRS-2A, is also required.
|VRS-2A||Designation of Beneficiary - Continuation||02-2020|
|VRS-5||Application for Service Retirement||08-2020|
|VRS-15||Request for Income Tax Withholding||08-2020|
Request for Health Insurance Credit
Retired participants who do not have premiums deducted from their VRS monthly benefit must complete this form.
|VRS-57||Authorization for Direct Deposit of Monthly Benefit||08-2019|
|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-900||Authorization to Discuss VRS Account Information||02-2011|
|VRS-901||VRS Durable Power of Attorney||01-2021|