Member and Retiree Forms

Online Forms - Make Updates via My PERA Account

Did you know you can make updates to your account electronically? Login to manage your account or submit forms for a selection of the categories indicated below.

Downloadable PDFs - Browse by Category

Refund/Rollover Request

Refund/Rollover of Your PERA DB Plan Account Tax Considerations for Refunds and Rollovers Defined Benefit Plan Refund by Direct Deposit Financial Institution Certification Form W-4R

Retirement

Online (login required)

PDFs (downloadable)

PERA Benefit Structure Retirement Application Denver Public Schools (DPS) Benefit Structure Retirement Application Direct Deposit by Electronic Funds Transfer (EFT)Form W-4P Colorado State Withholding Form Final Six Months' Salary Report

Direct Deposit and Deduction Authorization

Online (login required)

Direct Deposit by Electronic Funds Transfer (EFT) (monthly benefit payments)

PDFs (downloadable)

Direct Deposit by Electronic Funds Transfer (EFT) (monthly benefit payments)Authorization for Strength in Change Foundation Deduction Authorization for a Credit Union or Bank Deduction

Member Information Form

Member Information Form Member Information Form - Spanish

Address Change

Online (login required)

Address Change Form (DB Plan, DC Plan, PERAPlus, Life Insurance)

PDF (downloadable)

Address Change Form (DB Plan, DC Plan, PERAPlus, Life Insurance)

Beneficiary Change

Online (login required)

Beneficiary Change Form (Defined Benefit Plan)

PDFs (downloadable)

Member Information Form (Defined Benefit Plan)Retiree Named Beneficiary Change Form Life Insurance Beneficiary Designation Form

Disability

Online (login required)

Disability Program Application

PDF (downloadable)

Disability Program Application

Divorce/Domestic Relations Orders

Domestic Relations Order Agreement for Domestic Relations Order Authorization to Release Financial Information in a Divorce

Health Benefits (PERACare)

Online (login required)

PDFs (downloadable)

PERACare 2023 Enrollment/Change Form - Medicare Coverage PERACare 2023 Enrollment/Change Form - Pre-Medicare Coverage PERACare 2023 Enrollment/Change Form - Combination Pre-Medicare and Medicare Coverage Medicare Card Submission Form Certification of Previous Health Care Coverage PERACare Automatic Payment Authorization PERACare Program Cancellation

Life Insurance

Life Insurance Enrollment Form Life Insurance Beneficiary Designation Form Life Insurance Termination of Coverage Form

Purchasing Service Credit

Online (login required)

Purchasing Service Credit Application

PDF (downloadable)

Purchasing Service Credit Application

401(k) Plan (PERAPlus)

401(k) Contribution Authorization Form PERAPlus 401(k)/457 Plan Participant Employment Termination Notification Form PERAPlus 401(k) Plan Beneficiary Designation FormPERAPlus 401(k) Participant Information Form

457 Plan (PERAPlus)

PERAPlus 401(k)/457 Plan Participant Employment Termination Notification Form PERAPlus 457 Plan Beneficiary Designation FormPERAPlus 457 Participant Information Form PERAPlus 457 Plan Special or Sick/Annual Payments Deferral Form

Defined Contribution (DC) Plan (PERAChoice)

PERAChoice Years 2-5 Change/Transfer Form PERA DC Plan Participant Information Change Form

Authorization to Release Information

Authorization to Release Financial Information in a Divorce Authorization to Release Information Authorization to Use and/or Disclose Personal Health Information (PHI)

School Certifications (for benefit contingencies)

School Attendance Certification Summer Eligibility Certification Non-Traditional School Attendance Certification