Forms
Beneficiary Designation | Refunds & Distributions | Rollovers | Account Authorization | Other VRS Forms
Important: Most forms do not apply to both components of the Hybrid Retirement Plan. Use the third column to determine if the form is needed for the Defined Benefit (DB) or Defined Contribution (DC) component.
| Beneficiary Designation Note: Beneficiaries must be designated separately for both components. |
||
|---|---|---|
| Form Name | Download | Component Type |
| Beneficiary Designation (VRS-2) Update beneficiaries online through your secure myVRS account. |
N/A | DB |
| Beneficiary Designation Log in to choose or change the designated beneficiary for your account. This will ensure an immediate update to your beneficiary information. |
Login | DC |
| Refunds & Distributions | ||
|---|---|---|
| Form Name | Download | Component Type |
| Request for Refund (VRS-3) VRS now processes refunds online. Log in to myVRS to submit your refund request. |
N/A | DB |
| IRS 402(f) - Special Tax Notice Before taking a refund, read this notice which explains the tax consequences of taking a refund. |
 View |
DB |
| Direct Rollover/Transfer Request Log in to your account and download the Direct Rollover/Transfer Request Form to request a rollover or transfer from the plan. |
Login | DC |
| Distribution Request Log in to your account and select Withdrawals to request a full, partial, installment, or required minimum distribution (RMD) from your account. |
Login | DC |
| In-Service Distribution Request Log in to your account and download the In-Service Distribution Request Form to request a withdrawal from money that was previously rolled into the plan from another retirement plan. |
Login | DC |
| Workforce Transition Act (WTA) Distribution/Rollover Request Form Log in to your account and download the Workforce Transition Act (WTA) Distribution/Rollover Request Form if you have separated employment and are receiving benefits under WTA. |
Login | DC |
| Beneficiary Claim Request Form This form is used by beneficiaries to claim account assets when a participant has passed away. |
View |
DC |
| IRS Form W-4P: Withholding Certificate for Pension or Annuity Payments Use this form if you would like to change your tax withholding on your distribution. |
View |
DB, DC |
| Rollovers | ||
|---|---|---|
| Form Name | Download | Component Type |
| Incoming Rollover Form Use this form to request a direct rollover of your assets from your previous employer’s retirement plan (401(a), 401(k), Governmental 457(b), 403(b), Federal Thrift Savings) to your Hybrid 457 Deferred Compensation Plan. |
View |
DC |
| Coronavirus-Related Distribution (CRD) Repayment Form Use this form to repay your CRD within three years of taking the distribution. |
View |
DC |
| Account Authorization | ||
|---|---|---|
| Form Name | Download | Component Type |
| Authorization to Discuss VRS Account Information (VRS-900) | View |
DB |
| Durable Power of Attorney (VRS-901) | View |
DB |
| Information Release Authorization Use this form to authorize a third party to obtain information regarding your account. Please note that it does not authorize this individual to conduct transactions on your behalf. |
View |
DC |
Forms
| Other VRS Forms | ||
|---|---|---|
| Form Name | Download | Component Type |
| Securian Financial/VRS Life Insurance Forms: VRS-31, VRS-32, VRS-35, VRS-37, VRS-38, VRS-39, VRS-39A, VRS-39R and VRS Certificate of Life Insurance. |
 View |
DB |
| State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants (A10741) |  View |
DB |
| College and University Opt-Out Form (VSDP-2) | View |
DB |
| Name and Address Declaration for Deferred Members (VRS-3A) | View |
DB |
| Application for Retirement (VRS-5) Before completing the form, log in to myVRS for retirement counseling resources and review the Apply for Retirement page to determine if you can retire online. |
View |
DB |
| Request for Income Tax Withholding (VRS-15) | View |
DB |
| Application for Purchase of Prior Service Credit (VRS-26) | View |
DB |
| Authorization for After-Tax Payroll Deduction to Purchase Service Credit (VRS-26C) VRS members now select payment agreement type in myVRS and provide confirmation details page to employer. |
N/A | DB |
| Agreement for Pre-Tax Salary Reduction to Purchase Service Credit (VRS-26E) VRS members now select payment agreement type in myVRS and provide confirmation details page to employer. |
N/A | DB |
| Application for Contribution Make-Up for Hybrid Plan Participants Returning from Military Leave (VRS-26M) | View |
DC |
| Request for Health Insurance Credit (VRS-45) | View |
DB |
| Approved Domestic Relations Orders - Defined Benefit Plan The Code of Virginia authorizes VRS to make a direct payment to a former spouse if the court awards your former spouse part of your benefit. In this situation, provide this form to your attorney to submit. |
View |
DB |
| Approved Domestic Relations Orders - Defined Contribution Account(s) The Code of Virginia authorizes VRS to make a direct payment to a former spouse if the court awards your former spouse part of your benefit. In this situation, provide this form to your attorney to submit. |
View |
DC |
| Authorization for Direct Deposit of Monthly Benefit (VRS-57) Retirees can update direct deposit information online through myVRS. |
View |
DB |
| Name and Address Declaration for Retirees (VRS-58) | View |
DB |
| Request for Review of Membership Records (VRS-70) | View |
DB |
| Authorization of Coverage Retention for the Long Term Care Plan (VSDP or VLDP) (VRS-170) | View |
DB |
| Protection Against Unintentional Lapse of Long Term Care (VSDP or VLDP) (VRS-171) | View |
DB |