Other VRS Forms | ||
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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 |