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
VSDP-2 College and University Opt-Out Form 09-2011
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