Forms and Publications

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For Active Members 

Beneficiary Nomination Form (R0315C)  
This form designates a beneficiary for a monthly pension in the event of the death of an active public school employee.

Name and Address Change Form (R0357X)
Use this form to change your name and address with ORS.

Eligible Domestic Relations Order (EDRO) (R0259X)
This document provides background information for active members dividing a pension as part of a divorce.

Publication: Your Retirement Plan: A Member Handbook for Michigan's Public School Employees 
This plan overview is a useful reference at any stage in your career. It provides general information about your retirement plan, as well as suggestions for long-term retirement planning.

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Service Credit Applications

Universal Buy-In - Please contact ORS and request a Member Billing Statement .

Maternity, Paternity or Child Rearing Time (R0008C) 
If you reduced your hours or left public school employment for parental leave - maternity, paternity, or child rearing time - you may be eligible to buy up to five years of retirement credit for those time periods.

Out-of-System or Nonpublic Educational Credit (R0149C) 
As an active member of the Michigan Public School Employees Retirement System, you my purchase out-of-system and nonpublic educational service at any time

Military Service Credit (R0081C)
Use this form to apply for service credit for time you spent in active duty military service.

Sabbatical Leave Credit (R0148C) 
As an active member of the Michigan Public School Employees Retirement System, you mnay receive credit for an authorized sabbatical leave of absence.

State of Michigan Credit (R0317C) 
Use this form to receive retirement credit for the years you worked for the state of Michigan and were a member of the State Employees' Retirement System.

Weekly Workers Compensation Credit (R0285C)  
Use this form to request service credit for weekly workers' compensation (WWC) paid to you before July 1, 1992 only.

Comprehensive Employment and Training Act (CETA) - Contact ORS to request.

Publication: Enhancing Your Pension: Earning and Purchasing Service Credit
For members who are interested in increasing their pension amount, or qualifying earlier, by adding to their service credit. The booklet includes details on the types of service credit available, how to apply, and different ways to pay.

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Tax-Deferred Payment and Rollover Forms

Service Credit Payment Options (R0648C) 
Summarizes the ways you can pay for your service credit purchase.

TDP Agreement (R0392C) - Contact ORS to request.

Qualified Plan-to-Plan Transfer Certification (R0158X)
This form is used if you wish to transfer funds from a qualified retirement plan (401(a), 401(k), 403(b), or 457) to purchase service credit.

Supplemental TDP Agreement (R0654C)
Use this form only if you have a current Tax-Deferred Payment (TDP) agreement and wish to increase a tax-deferred payroll deduction.

Payoff Payment Options for a TDP Agreement (R0518C)
You can use this form only if you are retiring or terminating employment and need to pay off a current Tax-Deferred Payment (TDP) agreement.  

TDP Agreement Addendum (R0625C)
Use this form to transfer a TDP agreement to a new Michigan public school employer.

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For Terminating or Deferred Members

Beneficiary Nomination Form (R0315C) 
This form designates a beneficiary for a monthly pension in the event of the death of an active public school employee.

Refund Application (R0311C)
Use this form if you have terminated employment and would like to withdraw your contributions on account with the Public School Employees Retirement System. 

Name and Address Change Form (R0357X) 
Use this form to change your name and address with ORS.

Payoff Payment Options for a TDP Agreement (R0518C) 
You can use this form only if you are retiring or terminating employment and need to pay off a current Tax-Deferred Payment (TDP) agreement.

Publication: Leaving Public School Employment?
If you're not yet eligible to retire, either because you don't have enough service credit ot you're too young to qualify for a monthly pension, this publication will help you understand how your retirement plan will be affected.

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Retirement Application Forms

For a complete retirement application packet, contact ORS.

Retirement Application Checklist (R0118C) 

Application for Retirement (R0009C) 
Use this form to apply for retirement benefits based on your age and years of service.

Election of Pension Option (R0010C)
Use this form to select your pension option and beneficiary for your pension.

Insurance Information (R0058C)
This document provides you with basic information about the health, dental, and vision insurance coverage available to retirees.

HMO Pilot Program Option (R0379C)

Group Insurance Application (R0365C) 
Use this form to apply for retiree health, vision, and dental insurance.

Pension Recipient's Federal Income Tax Withholding Authorization (R0012X) 
Use this form to change the federal income tax withholding on your retirement pension.

Electronic Funds Transfer (Direct Deposit) Application (R0277X) 
Use this application to have your monthly pension automatically deposited into your checking account or savings account.

Publication: Retirement Readiness: A Two-Year Countdown 
For members who are within a few years of retiring. This book contains specifics on how pensions are calculated, the various payment options, how to prepare for retirement, and the application process.

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For Disability Applicants

Publication: If You Become Disabled: Your Disability Protection
For members who are facing an illness or injury that prevents them from working. This brochure defines the criteria to receive a disability benefit and gives an overview of the application process.

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For Retirees

Electronic Funds Transfer (Direct Deposit) Application (R0277X) 
Use this application to have your monthly pension automatically deposited into your checking account or savings account.

Name and Address Change Form (R0357X) 
Use this form to change your name and address with ORS.

Insurance Information (R0058C)  
This document provides you with basic information about the health, dental, and vision insurance coverage available to retirees.

HMO Pilot Program Option (R0379C)

Insurance Change Request (R0452X) 
Use this form to change retiree health, vision, and dental insurance.

Insurance Rates (R0072C) 

Pension Recipient's Federal Income Tax Withholding Authorization (R0012X)
Use this form to change the federal income tax withholding on your retirement pension.

Domestic Relations Order (DRO)(R0323X)
This document provides background information for retirees dividing a pension as part of a divorce.

Refund Beneficiary Designation for Retirees (R0748X)
Use this form to change your retirement refund beneficiary.

Publication: After You Retire: What Every Pension Recipient Should Know booklet
You will receive this booklet when you apply for your pension. It tells you what to expect, and how and when you should contact ORS after your retirement benefits begin.

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Publications

Your Retirement Plan: A Member Handbook for Michigan's Public School Employees 
This plan overview is a useful reference at any stage in your career. It provides general information about your retirement plan, as well as suggestions for long-term retirement planning.

Enhancing Your Pension: Earning and Purchasing Service Credit 
For members who are interested in increasing their pension amount, or qualifying earlier, by adding to their service credit. The booklet includes details on the types of service credit available, how to apply, and different ways to pay.

Retirement Readiness: A Two-Year Countdown 
For members who are within a few years of retiring. This book contains specifics on how pensions are calculated, the various payment options, how to prepare for retirement, and the application process.

After You Retire: What Every Pension Recipient Should Know 
You will receive this booklet when you apply for your pension. It tells you what to expect, and how and when you should contact ORS after your retirement benefits begin.

Leaving Public School Employment?
If you're not yet eligible to retire, either because you don't have enough service credit ot you're too young to qualify for a monthly pension, this publication will help you understand how your retirement plan will be affected.

If You Become Disabled: Your Disability Protection 
For members who are facing an illness or injury that prevents them from working. This brochure defines the criteria to receive a disability benefit and gives an overview of the application process.

Comprehensive Annual Financial Report (CAFR)

Eligible Domestic Relations Order (EDRO) (R0259X)
This document provides background information for active members dividing a pension as part of a divorce.

Domestic Relations Order (DRO)(R0323X)  
This document provides background information for retirees dividing a pension as part of a divorce.

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