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Tier One/Tier Two 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 (RAAS), bring all of these forms to your session.

Note: The retirement option you choose may affect which tax forms must accompany your retirement application. Click on the "Tax Forms Decision Chart" below for more inf​ormation. Also bring your tax forms to your RAAS.

​Tier One/Tier Two/IAP Retirement Application​

Tax Forms Decision Chart​  — ​ Use this chart to help you decide which tax forms you need to complete along with your retirement application.

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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 — Form to withhold income tax from retirement benefit.

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.

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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.​​

Rollover-Eligible Distribution — Required only if you elect a lump-sum payment option and you wish to roll over the benefit.

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.

Trustee-to-Trustee Transfer to PERS for Purchases —​ Form to purchase service time using pre-tax dollars from a 457 governmental-deferred compensation plan like the Oregon Savings Growth Plan (OSGP) or a 403(b) tax-sheltered annuity.

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​​​​​​Tier One/Ti​er Two Preretirement Guide

PERS Tier One/Tier Two Prer​etirement Beneficiary Designation 

Information Change Request — Change your name, Social Security number,or address.

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

Estimate Request — Request an estimate.

PERS Additional Estimate Fee Agreement — Request an additional estimate.

W-4R Tier One/Tier Two Lump-Sum Tax Withholding​ ​​ — Form to elect lump-sum withdrawal withholdings.

Direct Transfer Rollover Acceptance — Roll over your benefit to a qualified employer or compensation plan.

Direct Deposit — Set up an automatic deposit of your benefit payments.

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

Data Verification Request — Active or inactive members who are within two years of their earliest retirement age can request a verification of certain data.

Data Verification Fee Agreement — Form is required for any additional data verification requests.

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.

​Elective and Appointive Membership Election — Form for a person who  holds an elective or appointive office and elects to become an active member of PERS Tier One/Tier Two and IAP programs.

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

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.

One Time-Variable Transfer: Active or Inactive Members — Use this form to transfer funds out of a variable account into a regular account.

Acknowledgment of Potential Consequences Relating to Working After Retirement

Release Time Certification​

Tier One Tier Two Lump Sum or Total Lump Sum Benefit Request​

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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.