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OPSRP forms

​​The following packet contains required forms you need to successfully apply for retirement. Review and complete all forms in this packet. If you are attending a retirement application assistance session, bring all of these forms to your session.

​OPSRP-IAP Retirement Application​​ - As of January 1, 2011, you must retire from the OPSRP Pension Program and the Individual Account Program (IAP) at the same time.

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​​​​​​​​​If you wish to apply for retirement and need forms, click on “Retirement Application Packet" above and complete the forms in the packet. Submitting an incomplete retirement application may delay your retirement process.

The forms listed individually here are provided for other times you may need these forms, such as to update your tax withholding (W-4P) or your banking information (direct deposit).

W-4P Federal tax withholding​ form.

​Direct Deposit – Required if you want to set up an automatic deposit of your benefit payments.​

Federal Tax Information and Acknowledgement

Verification of Age - List of acceptable documents for verification of age, which is required before payment of benefits.

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​​IAP Direct Transfer Rollover Acceptance​ - Required only if you want to roll over your IAP balance to a qualified employer or deferred compensation plan.​

​​W-8BEN - Form to withhold income tax or claim treaty rights for non-resident, non-U.S. citizen persons.

W-9 - Required for any person with a foreign address.

Direct Deposit - Set up automatic deposit of your benefit payments.

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IAP Pre-Retirement Designation of Beneficiary Packet (Please note that there is no form to designate a beneficiary for your OPSRP pension, as statute only allows PERS to pay a death benefit to a member's spouse, or to any other person who is constitutionally required to be treated in the same manner as a spouse for the purpose of retirement benefits. Therefore, the IAP Pre-Retirement Designation of Beneficiary form is the only beneficiary form you need to fill out)

Information Change Request - Change your name, SS number, or address.

Date of Birth Change Request - Notice: Please use this new form to update your date of birth.

Data Verification Additional Account Information - This form allows you to provide additional information for your Data Verification Request.

Data Verification Request - Tier One/Tier Two and OPSRP Pension Program active or inactive members who are within two years of their earliest retirement age can request a verification of certain data.

Estimate Request - Form to request an OPSRP benefit estimate.

Estimate Request Fee Agreement - Form to requesting more than two estimates in a year.

OPSRP Elective and Appointive Membership Election - Form for a person who holds an elective or appointive office and wants to elect not to become an OPSRP Pension Program member.

Special Power of Attorney - This form gives the person(s) you designate the power to make any and all decisions for PERS-related matters on your behalf.

Authorization to Release Account Information - This form allows you to authorize a third party to obtain information regarding your PERS account or benefits.

Account Reconciliation Request - Form to capture and document concerns about the accuracy of your employment information for subsequent review and reconciliation by PERS staff.

Withdrawal information - For those who are not eligible to retire and not working for a PERS-covered employer.

OPSRP Dispute of Notice of Entitlement - This form allows a member to dispute the accuracy of the information used in the computation of their retirement benefit.

OPSRP Rollover-Eligible Distribution - Used only if you are eligible for a one-time, lump-sum OPSRP pension payment because your benefit is calculated as less than $200 a month.

Workers' Compensation Certification - This form is to request service credit under Oregon Revised Statutes Chapter 238.175 for periods of workers’ compensation or disability.

W-4R OPSRP Lump Sum Withholding - Form to elect lump-sum withholdings.

OPSRP Direct Transfer Rollover Acceptance - Roll over your benefit to a qualified employer or compensation plan

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​​​Troubleshooting

If you are experiencing problems opening a form, use the appropriate link below.

PERS provides all online forms and publications in .pdf format. To view them, you must have the most recent version of Adobe Reader. Download Adobe Reader.

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Notarization

PERS accepts documents with remote online notarization by vendors that meet the requirements of the Oregon Secretary of State.

To be accepted by PERS, notarized documents also must meet the following requirements:

  • The signature date of the member and the notary must match.
  • If notarized spousal consent is required on a document, the signature dates of the spouse and the notary must match.