| ACERA Enrollment Form (Member Enrollment Questionnaire) |
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| Active or Deferred Member Beneficiary Designation Form |
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| Address and Name Change Form (Retirees, Payees, and Deferred Members) |
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PDF |
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| Affidavit of Dependent Eligibility |
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PDF |
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| Affidavit of Domestic Partnership |
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PDF |
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| Agreement and Order for Division of Retirement Benefits – Separate Records |
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PDF |
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| Agreement and Order for Division of Retirement Benefits – Shared Records |
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PDF |
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| Application For Disability Retirement (Sample Only) |
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PDF |
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| Application for Service Retirement |
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| Aquilino Tier 1 Restoration Application |
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PDF |
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| Authorization for Release of Information and Documents |
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PDF |
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| Community Property Estimate Request Form |
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PDF |
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| Continuance Beneficiary Addendum |
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| Declaration of Qualification for Registration as Domestic Partners |
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PDF |
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| Dental Plan Enrollment Form |
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PDF |
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| Direct Deposit Form |
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PDF |
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| Disability |
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| HIPAA Authorization Form |
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PDF |
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| HIPAA Cancellation Form |
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PDF |
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| IRS Form W-9 |
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PDF |
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| Kaiser Permanente Senior Advantage (KPSA) Enrollment Form |
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PDF |
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| Lump-Sum Death Benefit Beneficiary Addendum |
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| Medical Plan Enrollment Form |
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PDF |
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| Medicare Part B Reimbursement Plan (MBRP) Application Form |
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PDF |
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| Member Enrollment Questionnaire |
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PDF |
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| Non-Member Application for Retirement Allowance |
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PDF |
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| Non-Member Beneficiary Form |
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PDF |
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| Notice of Claim |
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PDF |
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| Other Public Service Verification Form |
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PDF |
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| Power of Attorney |
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PDF |
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| Purchase Request Form |
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| Purchase Request Form FAQ |
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PDF |
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| REAC Enrollment Form |
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| Report a Death Form |
Web Form |
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| Request for Joinder Packet |
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PDF |
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| Retired Member Beneficiary Designation Form |
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PDF |
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| Retiree Association – ACRE Enrollment Form |
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PDF |
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| Retiree Associations – ACRE and REAC Membership Termination Form |
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| Retirement Estimate Request Form |
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| Retirement Payment Option Addendum |
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| SSA-44 Form (Medicare Income-Related Monthly Adjustment Form) |
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| Survivor Continuance Recipient’s Designation of Beneficiaries Form |
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PDF |
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| Tax Withholding Designation Form (IRS Federal Form W-4P) |
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| Tax Withholding Designation Form (State of California) |
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| Termination Election of Membership Request Form |
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PDF |
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| Termination of Domestic Partnership |
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PDF |
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| Verification of Enrollment Status |
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PDF |
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| Via Benefits Reimbursement Forms |
Website |
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| Vision Plan Enrollment Form |
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PDF |
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| VSP Reimbursement Forms: Login at VSP website |
Website |
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