Member Forms

Retirement or Refunds

If you’re vested and want to collect your monthly benefit.

Take a refund or rollover of your contributions plus interest.

Other PERA Forms

General Forms

Change Form

Change your name, address, remove or add beneficiaries.

Release of Information

Use this form to release your personal information to another individual, agency, or firm. PERA will not release information without your consent.

Leave Verification

Use these forms to receive an estimate of the cost of purchasing service credit or maintaining your high-five salary for a leave of absence. Use this form for a non-military leave such as a personal, medical, or parental leave.

Leave Verification - Military

Use these forms to receive an estimate of the cost of purchasing service credit or maintaining your high-five salary for a leave of absence. Use this form for a military leave.

Benefit Recipients

Direct Deposit

Use this form for electronic deposit of your monthly benefit to your checking or savings account.

Your Pension and Taxes

A form to help you calculate your state and federal tax withholding

Tax Withholding Preference/Change Certificate

A form to change federal/state tax withholding from a PERA benefit..

Payment Recipient Address Change

If you are currently receiving a PERA benefit and need to change your address.

Specialty Forms

Defined Contribution Plan

DCP Investment Selection

Employees should use this form to make alterations to how funds are invested in the Define Contribution Plan, or to transfer funds from previous investment choices into new ones.

Application for Defined Contribution Withdrawal (Active Employee)

Complete this form if you are employed by a Minnesota public employer and at least age 65. You may elect a distribution of all or a portion of your Defined Contribution Plan (DCP) account no more than once each calendar year.

Statewide Volunteer Firefighter (SVF)

Statewide Volunteer Firefighter Retirement

Application for SVFRP Lump-sum benefit. Complete this form to apply for a lump-sum retirement benefit from the Statewide Volunteer Firefighter Retirement Plan (SVFRP).

SVF Application for Lump Sum Survivor Benefit

Used by the survivor of a firefighter who dies prior to receiving his or her retirement benefit.

Phased Retirement Option & Other Forms

Phased Retirement Option Agreement

Complete this form to indicate an agreement between employer and PERA-covered employee to phase into retirement. This form should accompany a completed Application for PERA Retirement Benefits. As applicable, a signed copy of any subsequent Phased Retirement Agreement must also be provided to PERA prior to its effective date.

Independent Contractor or Employee?

Complete this form to determine if you are an independent contractor or working in a PERA-covered position.