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Employers Forms
Important Notice - Instructions
Reporting - EDX
Paper Reporting - Payroll / Electronic Remittance
Paper Reporting - Personnel
Paper Reporting - Member & Beneficiary
Important Notice - Instructions
PERS provides all online forms and publications in PDF format. They can be opened using Adobe Reader© software. Please ensure you have the most recent version of Adobe Reader©.
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For your convenience these forms are available to download, be completed and sent by mail or by fax to PERS (Attention: Membership and Employer Relations)
Please follow these instructions. If you do not, we may not be able to process your form(s).
  • Step 1: Select the desired form(s) by clicking the link(s) below.
  • Step 2: Refer to the instructions attached to each form. You can also refer to your Employer Manual for specific instructions for each form and to determine any additional documentation that may be needed.
  • Step 3: Submit the form and additional documentation to the Oregon Public Employees Retirement System
  • Step 4: Complete and sign the form(s) with blue or black ink. Do not use pencil.
 
How to submit the forms
  • By mail: Mail the form(s) and documentation to the Oregon Public Employees Retirement System, P.O. Box 23700, Tigard, Oregon, 97281-3700.
  • By Fax: (503) 603-7626 (Attention Membership and Employer Relations)
  • In person: Deliver the form(s) and documentation to the Oregon Public Employees Retirement System offices at: 11410 SW 68th Parkway, Tigard, Oregon
 
Caution
  • We will not accept electronic (e-mail) documents.
  • Material should not be sent via e-mail for confidentiality reasons.

Reporting - EDX
Demographics Report
Demographics Correction Report
New Employer (ER) Data
PERS Wage and Service Data
Web Administrator Agreement

Paper Reporting - Payroll / Electronic Remittance
Notice of Unit Election
P&F Discontinue Unit Contribution
Salary Breakdown
ACH Agreement 
ACH Debit Authorization 
Employer Request for Penalty Waiver   
 
 
 
 

Paper Reporting - Personnel
Certification of Individual Contract for 2002-03 school year lookback calculation ( only use this form for 2002-03 lookback calculations)
Certification of Individual Contract
Salary Certification for Retirement Benefits
Employment Class Change
Leave of Absence Without Pay
Notice of Employment in a PERS-Covered Position
Notice of Leave Without Pay for Career Development
Notice of Separation from a PERS Covered Position 
Notice of Separation for 2003 Lookback 
Disability Leave without Pay
Temporary Employment Class Change
Sick Leave Information Request
Temporary Special PERS Employment Coverage
USERRA - Uniformed Services Employment and Reemployment Rights Act
Corrected Separation from a PERS covered employer  
 
 
 
 
 

Paper Reporting - Member & Beneficiary
Pre-Retirement Designation of Beneficiary Packet
PERS (Tier One/Tier Two) Elective and Appointive Membership Election
OPSRP Elective and Appointive Membership Election
IAP: Pre-Retirement Designation of Beneficiary Packet   
IAP: Revocation of Spousal Beneficiary Designation
Legislators: Retirement Plan Election  
Transfer of Legislator PERS Chapter 238 Account
Certification of Out-of-State Police Service

 
Page updated: June 25, 2008

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