Forms, Charts & Retirement Guides

Forms for Current / Active Members

• Beneficiary Selection Form – Return of Accumulated Deductions
• Beneficiary Selection Form – Option D (If Member Dies Before Retirement)
• DCCRS Name Address Change Form
• Retirement Estimate Request Form
• Request for Retirement Account Information Form
• Notice of Potential Veterans’ Benefits

Withdrawal / Rollover Forms (Inactive Members)

• Application for Withdrawal of Accumulated Deductions (Refund Form)
• MANDATORY Supplemental Withdrawal Form
• Special Tax Notice Regarding Lump Sum Distributions (used with Application for Withdrawal for Accumulated Total Deductions)

Forms for Retirement

• Application for Voluntary Superannuation Retirement
• Choice of Option at Retirement Form
• Supplemental Retirement Application Form
• Member Application for Disability Retirement
• Involuntary Retirement Application Form
• Physician’s Statement Pertaining to a Member’s Application for Disability Retirement
• W-4P – Use this form to change your federal tax withholding

Forms for Employer Units

• New Member Enrollment Form
• Supplemental New Member Enrollment Form
• Statement Concerning Your Employment in a Job Not Covered by Social Security
  (used with New Member Enrollment Form)
• Beneficiary Selection Form – Return of Accumulated Deductions
• Beneficiary Selection Form – Option D (If Member Dies Before Retirement)

Retirement Charts

• Group 1 – Hire Date Prior to April 2, 2012
• Group 1 – Hire Date On or After April 2, 2012
• Group 4 – Hire Date Prior to April 2, 2012
• Group 4 – Hire Date On or After April 2, 2012

Retirement Guides

• Retirees Rights and Responsibilities
• Guide to Retirement Benefit Calculations
• Retirement for Public Employees of the Commonwealth
• For Employees Who Became Members Prior to April 2, 2012
• For Employees Who Became Members On or After April 2, 2012
• Disability Retirement Guide
• Survivor Benefits for Employees Who Became Members Prior to April 2, 2012
• Survivor Benefits for Employees Who Became Members On or After April 2, 2012