Use this form to enroll in all ACERA medical plans except for individual plans through Via Benefits and individual Kaiser Permanente plans outside of California.
When you are within 60 days of your chosen retirement date, you may complete and submit an ACERA retirement application. On your retirement application you will write your chosen retirement date as well as choose a beneficiary or beneficiaries for continuance death benefits. You can even submit an application the day before you retire.
Use this form for ask ACERA to calculate the cost of purchasing eligible time as service credit. Learn more about service credit on our service credit page.
1/11/19 Update: The state of California has not issued an updated Tax Withholding Designation Form DE 4P yet for 2019. Continue using the attached 2018 form, or check the state’s website for further updates. You can find the date at the bottom of the form in small print. If it says (12-17) it hasn’t been updated.
