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