Retiree Info and Forms

These are the most commonly used and requested forms.
If you do not find what you need in this list, contact the Benefits Customer Service Team via email or at 703-228-3500, Option 1; 10 am to 4 pm.

• Application — Deferred Vested Retirement(PDF, 3MB)
• Application — Service Retirement(PDF, 2MB)
• Application — DROP Entry(PDF, 1MB)
• Application — DROP Exit(PDF, 4MB)
• ACERS Pension Beneficiary Designation(PDF, 278KB)
• (PDF, 278KB)In-Service Joint & Survivor Designation (for active employees)

• Policy on Retiree Health Insurance Changes(PDF, 187KB)
• (PDF, 278KB)Life Insurance Beneficiary Designation – The Hartford
• Direct Deposit Form for ACERS Pension
• Income Tax Withholding Changes for Federal Taxes
• Income Tax Withholding Changes for Virginia State Taxes(PDF, 187KB)

• (PDF, 193KB)ACERS Pension Refund or Rollover Packet(PDF, 193KB)
• Instructions for (PDF, 415KB)(PDF, 415KB)former employees access to W-2 and pay slips(PDF, 415KB).(PDF, 415KB)

Click here for information about Open Enrollment. 

• ACREA Membership Form(PDF, 151KB)
  

• Medicare Creditable Coverage Notice(PDF, 151KB)