The first two sections of the benefit estimate form are self-explanatory (e.g., name, address, and whether you expect to
be an Oregon resident when you retire). So, let’s start with section C.
Section C
PERS retirements may only be on the first of a month. Hence, the form only asks for the month and year of the expected
retirement date.
The last day employed would be the last business day the member was employed or expects to be employed.
Section D
For this form, the member can enter any beneficiary they want — except for themselves.
Section E
The Sick Leave Hours field is asking for the total number of hours of unused sick leave the employee expects to have in
their account when they terminate employment. This is not the same as the calculated number the employer will report to
PERS at retirement.
The Vacation/Compensatory Hours field only applies to Tier One members. Tier Two members leave the field blank. Tier One
members enter the amount their organization will pay them for their vacation and comp time when they retire.
Hourly Salary $ is the employee’s current gross hourly salary.
Section F
The member fills out section F only if they would like estimates for additional purchases.
If the member checks the Police Officer and Firefighter Unit Purchase box, PERS will include the cost to purchase Police
and Fire units. Units are different from purchases. To learn more about units, read
employer reporting guide 16,
Reporting a Retirement
, section “Factors That Affect Retirement Benefits,” “Police and Fire ‘Units’” starting on page 9.
The “date to begin unit benefit payments” would be any date after the employee’s retirement date.
If the member checks the Other Purchases/Requests box, that indicates that they want to make a purchase, or receive an
estimated cost of a purchase, in addition to wait time and forfeited time.
In addition to checking the box, they need the write the name of the type of purchase in the box (e.g., military service
time, non-duty disability service time, out-of-state teaching time). Many of the additional service purchases require an
extra form to be submitted along with the estimate request. For example, a military full-cost purchase requires a copy
of the military discharge, a seasonal-time purchase requires a PERS seasonal form, and an out-of-state school service
time purchase requires a certification of out-of-state teaching.
Types of purchases (and links to the additional forms) are listed on the Tier One/Tier Two Purchases webpage under
General Service Time Purchases.
Section G
The form requires a real signature, so the member must print the form and sign it. It does not need to be notarized. The
member can then either mail it to PERS Member Services at PO Box 23700, Tigard OR 97281-3700; fax it to PERS Member
Services at 503-598-0561; or drop it off at the PERS office at 11410 SW 68th Parkway, Tigard, Oregon, 97223.