Forms

Retirement Process

• Application For Retirement
• Choosing a Retirement Date
• Retirement Process Guide

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Active & Deferred Vested

• Application For Retirement
• Beneficiary Designation Form
• Disability Retirement Information
• Federated Disability Retirement Rules and Procedures
• PF Disability Retirement Rules and Procedures
• Reciprocity Fact Sheet Election Form

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Retirees

• Address Change Form
• Automatic Deposit Authorization Form
• Name Change Form
• INS 100 (Health Benefits Form)
• INS 100 VEBA (Health Benefits Form)
• Premier One Deduction Authorization Form

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Federated

• Beneficiary Designation Tier 1 Federated
• Beneficiary Designation Tier 2 Federated
• Federated Retiree Association Election Form

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Police & Fire

• Beneficiary Designation Form Police & Fire
• Police & Fire Retiree Association Election Form

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Anthem

• Anthem HMO Enrollment Form
• Anthem PPO Medicare Enrollment Form
• Anthem HMO Disenrollment Form
• Anthem PPO Medicare Disenrollment Form
• INS 650 Medicare Transition

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Kaiser

• Kaiser NorCal Sr. Advantage Enrollment Form CA-Fillable
• Kaiser SoCal Sr. Advantage Enrollment Form CA-Fillable
• Kaiser Sr. Advantage Enrollment Form ( Hawaii)
• Kaiser Northwest Sr Advantage Enrollment Form
• Kaiser Sr. Advantage Disenrollment Form (CA-north and south)
• Kaiser Sr. Advantage Disenrollment Form (Hawaii)
• INS 650 Medicare Transition

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Tax Forms

• CA State Withholding Certificate for Pension or Annuity Payments
• IRS Withholding Certificate for Pension or Annuity Payments
• ORS TEFRA Annual Tax Withholding Notice
• Form W-9 Request for Taxpayer Identification Number and Certification
• FAQ 2023 Form W-4P and W-4R

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Standard Insurance Company

• Standard Insurance Company Request For Group Life Conversion Materials
• Standard Insurance Company Group Life Portability Insurance Application

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Life Insurance Company of North America

• Life Insurance Company of North America Application

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