| 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 |
|
