Member Forms
For Members of Any Fund
- W-4P: Federal Income Tax Withholding -- download from IRS Web site
- WH-4P: State Income Tax Withholding -- download from Indiana Commission on Public Records Web site
- Request for Public Records (State Form 52005)
- Rollover Acceptance Form for PERF and TRF (State Form 54767)
For Members of the Public Employees' Fund
- Application for Change of Beneficiary -- Active Member
- Application for Direct Deposit
- Application for Retirement Benefits
- Application for Rollover Savings Account (State Form 51003)
- Application for Surviving Dependent Pension Benefit
- Application for Survivor Benefits for a Spouse Eligible for Deceased Member's Pension and Annuity Savings Account
- Application for Survivor Benefits for a Spouse Eligible ONLY for Deceased Member's Pension
- Application for Survivor Benefits for a Dependent Eligible for Deceased Member's Pension and Annuity Savings Account
- Application for Voluntary Withdrawal to Purchase Service Credit from Another Governmental Retirement Plan - To make a withdrawal for this purpose, members should call (888) 526-1687 to initiate their withdrawal request via phone with a customer service representative.
- Authorization to Release Confidential Info
- Beneficiary Affidavit of Date of Birth
- Change of Address
- Change of Name
- Claim for Distribution of Contributions - To receive a distribution, members can log in to their PERF Online account to initiate their request for a distribution. Members may also call (888) 526-1687 to initiate their distribution request via phone with a customer service representative.
- Claim for Annuity Savings Account Distribution Because of Death for an Estate or Designated Beneficiary other than Spouse
- Claim for Annuity Savings Account Distribution Because of Death for a Spouse as Designated Beneficiary
- Election to Begin Receiving Benefits (Elected Officials age 55 with 20 years of service)
- Election to Begin Receiving Benefits (age 70 with 20 years of service)
- Election to Continue or Discontinue Receiving Benefits (Elected Officials)
- Employer Certification of School Service
- Employer's Report of Separation from Employment
- Form for Transfers Under the IN Uniform Transfers to Minors Act
- Investment Direction - Members can log in to their PERF Online account to complete their investment direction election, or call (888) 526-1687 to complete their request via phone with a customer service representative.
- Member Affidavit of Date of Birth
- Notice to Members Considering Social Security Integration (Option 61)
- Participation Election for School Corporation Employees
- Request for Estimate of Benefits
- Request for Estimate - Partial Lump Sum Distribution
- Request to Purchase Additional Service Credit
- Request to Purchase Out of State Service
- Request to Purchase Prior Military Service Credit
- Retiree Application for Change of Beneficiary and/or Pension Option
- Small Estate Affidavit
- Special Tax Notice Regarding Plan Payments
- Survivor Affidavit of Date of Birth
- Voluntary Contributions: Non-state employees ONLY
For Members of the Teachers' Retirement Fund
- Retirement Application (Printable)
- Affidavit of Applicant for Classroom Disability Benefit (State Form 21703)
- Affidavit for Court-Appointed Guardian of a Surviving Dependent Pension Benefit
- Affidavit for Direct Deposit of Retirement Benefit to a Revocable Trust (State Form Number Pending)
- Affidavit for Estate Valued at $50,000 or Less (State Form Number Pending)
- Application for Consent to Transfer (State Form 48839)
- Application for Surviving Dependent Pension Benefit (State Form 44513)
- ASA/5 ASA/6 Post Retirement Election (State Form 50798)
- Attending Physician's Statement (State Form 17296)
- Authorization to Release Confidential Info (State Form 54304)
- Calculator for Retirement Benefits (State Form 3240)
- Change of Address Form (State Form Pending)
- Change of Beneficiary (State Form 52332)
- Death Report Form (State Form 50790)
- Direct Deposit Form (State Form 47144)
- Direct Deposit Form Instructions
- Enrollment Form for New Members (State Form 37680)
- Five-Year Distribution Of The Annuity Savings Account To A Deceased Member's Surviving Beneficiary (State Form 54305)
- Forgery Affidavit (State Form Number 52660)
- Instructions for Withholding Certificate for Pension or Annuity Payments (Form W-4P)
- Internal Revenue Code Section 415 Limitation Calculation (TR09112)
- Irrevocable Election to Begin, Continue or Discontinue Retirement Benefits (State Form 54275)
- Irrevocable Payroll Deduction Authorization for Pre-Tax ASA (State Form 52595)
- IRS Determination Letter (Qualification Letter)
- Leave of Absence Service Request (State Form 24315)
- Lump Sum Distribution Election for Surviving Spouse (State Form 53931)
- Member Data Change (State Form 43567)
- Military Service Credit
- Power of Attorney (State Form 49614)
- Preliminary Estimate Request Retiree Change of Beneficiary/Survivor Beneficiary And/Or Retirement Option (State Form 49513)
- Proof of Birth Affidavit (State Form 54878)
- Request to Purchase Additional Service Credit (State Form 52006)
- Request to Purchase Prior Military Service Credit (State Form 54273)
- Rollover Savings Account Acceptance and Allocation (State Form 52178)
- Social Security Consent Form (State Form 50824)
- Special Tax Notice Regarding Plan Payments Under Governmental 401(a) Plans
- Statement of Superintendent Disability Benefits Application (State Form 17295)
- Transfer of Service Credit (State Form 36249)
- Voluntary Post-Tax Contributions Authorization (State Form 50895)
- Verification of Private School Service (State Form 49047)
- Verification of out of state service (State Form 49530)
- Verification of Prior Indiana Service (State Form 41625)
- Withholding Election for Payees of Death Settlement or Distribution Payments (State Form 07993)
For Members of the 1977 Police and Fire Fund
- Application for Designation of Beneficiary - Active Members
- Application for Disability Benefits
- Application for Membership in the 1977 Police Officers' and Firefighters' Pension and Disability Fund
- Application for Participation in Deferred Retirement Option Plan (DROP)
- Application for Retirement Benefits
- Application for Survivor Benefits
- Authorization to Release Confidential Information
- Claim for $12,000 Lump Sum Death Benefit (for Spouse)
- Claim for $12,000 Lump Sum Death Benefit (for Non-Spouse)
- Claim for Public Safety Officer Line of Duty Death Benefit for a Spouse, Child, or Dependent Parent as Beneficiary (State Form 51014)
- Claim for Distribution of Contributions - To receive a distribution, members can log in to their PERF Online account to initiate their request for a distribution. Members may also call (888) 526-1687 to initiate their distribution request via phone with a customer service representative.
- Marital Status Form to be filed with Retirement Application
- Public Safety Officer Authorization for Insurance Premium Deduction
- Request for Estimate of Partial Lump Sum Distribution
- Request for Withdrawal from Pension Relief Sub-Account
- Request to Purchase Prior Military Service Credit
- Request to Purchase Service Credit in Other Indiana Public Retirement Funds
- Request to Purchase Out of State Service Credit (State Form 54878)
For Members of the Judges' Retirement System
- Judges' Retirement System Application for Retirement Benefits
- Judges' Retirement System Application for Survivor Benefits
- Judges' Retirement System Authorization to Release Confidential Information
- Judges' Retirement System Claim for Distribution of Contributions - To receive a distribution, members can log in to their PERF Online account to initiate their request for a distribution. Members may also call (888) 526-1687 to initiate their distribution request via phone with a customer service representative.
- Judges' Retirement System Claim for Distribution Because of Death for the Spouse of a Member
- Judges' Retirement System Claim for Distribution Because of Death for the Estate of a Member
- Judges' Retirement System Claim for Distribution Because of Death for the Beneficiary of Dependent of a Member
- Magistrate Election to become a Member of the Judges 1985 Benefit System
- Request for Estimate of Benefits/Request to Purchase Service
For Members of the Legislators' Retirement System
For Members of the Prosecuting Attorneys' Fund
- PARF Application for Retirement Benefits
- PARF Application for Survivor Benefits
- Authorization to Release Confidential Information
- PARF Claim for Distribution of Contributions - To receive a distribution, members can log in to their PERF Online account to initiate their request for a distribution. Members may also call (888) 526-1687 to initiate their distribution request via phone with a customer service representative.
- PARF Claim for Distribution Because of Death for the Spouse of a Member
For Members of Excise, Gaming and Conservation Plan
- Application for Change of Beneficiary (Active Member, Employee Contribution Account)
- Application for Participation in Deferred Retirement Option Plan (DROP)
- Authorization to Release Confidential Information
- Excise, Gaming and Conservation Plan Application for Retirement Benefits
- Excise, Gaming and Conservation Plan Application for Survivor Benefits
- Excise, Gaming and Conservation Plan Membership Application
- Excise, Gaming and Conservation Plan Claim for Distribution of Contributions - To receive a distribution, members can log in to their PERF Online account to initiate their request for a distribution. Members may also call (888) 526-1687 to initiate their distribution request via phone with a customer service representative.
- Excise, Gaming and Conservation Plan Claim for Distribution Because of Death Estate or Beneficiary other than Spouse
- Excise, Gaming and Conservation Plan Claim for Distribution Because of Death for the Spouse of a Member
- Excise, Gaming and Conservation Plan Request to Purchase Prior Military Service
