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
To designate more than 3 beneficiaries, a continuation form, the VRS-2A, is also required.
07-2021
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
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