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
T-20879 State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants 03-2020
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-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-15 Request for Income Tax Withholding 08-2020
VRS-45 Request for Health Insurance Credit
Retirees can update health insurance policy information online through myVRS.
07-2021
VRS-57 Authorization for Direct Deposit of Monthly Benefit
Retirees can update direct deposit information online through myVRS.
06-2021
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