Forms Library

Approved Domestic Relations Orders – Defined Benefit

Provide this form to your attorney to submit if the court awards your former spouse part of your benefit.

Approved Domestic Relations Orders – Voya Defined Contribution

Provide this form to your attorney to submit if the court awards your former spouse part of your benefit.

Beneficiary Designation - VRS Defined Contribution Plans

Use this form to designate your VRS defined contribution plan beneficiaries. You may also update beneficiaries online at dcp.varetire.org/login. Note: Hybrid plan members must also name beneficiaries for your defined benefit account(s) with VRS.

College and University Opt-Out Form (VSDP-2)

Use this form if you wish to opt out of the Virginia Sickness and Disability Program (VSDP).

Direct Rollover/Transfer Request

Log in to your account and complete this form to request a rollover or transfer from your plan.

Distribution Request

Log in to your account and select Withdrawals to request a full, partial, installment, or required minimum distribution (RMD) from your account.

Dual Employment Form

Use this form if you work for more than one employer participating in the Commonwealth of Virginia 457 Deferred Compensation Plan and wish to make contributions to both plans.

In-Service Distribution Request Form - Cash Match Plan

Use this form to request a withdrawal from money previously rolled into the plan from another retirement plan, or an age 70½ withdrawal.

In-Service Distribution Request Form - COV 457

Use this form to request a withdrawal from money previously rolled into the plan from another retirement plan, or an age 70½ withdrawal.

In-Service Distribution Request Form - ORPHE, ORPPA, ORPSS, VSRP

Use this form to request a withdrawal from money previously rolled into the plan from another retirement plan, or an age 70½ withdrawal.

Incoming Direct Rollover Form - COV 457 Deferred Compensation Plan

Use this form to request a direct rollover of your assets from your previous employer’s qualified retirement plan to your VRS DCP account.

Incoming Direct Rollover Form - Virginia Cash Match Plan

Use this form to request a direct rollover of your assets from your previous employer’s qualified retirement plan to your VRS DCP account.

Incoming Rollover Form – Hybrid Plan Defined Contribution

Use this form to request a direct rollover of your assets from your previous employer’s qualified retirement plan to your Hybrid 457 Deferred Compensation Plan.

Incoming Rollover Form – ORPHE

Use this form to request a direct rollover of your assets from your previous employer’s qualified retirement plan to your VRS DCP account.

Incoming Rollover Form – ORPPA, ORPSS & VSRP

Use this form to request a direct rollover of your assets from your previous employer’s qualified retirement plan to your VRS DCP account.

Information Release Authorization Form

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.

IRS 402(f) - Special Tax Notice

Before taking a refund, read this notice which explains the tax consequences of taking a refund.

IRS Form W-4P: Withholding Certificate for Pension or Annuity Payments

Use this form to change your tax withholding on your distribution.

Payroll Authorization - One-Time Deferral Form - COV 457

Use this form to notify your employer’s Payroll Officer that you would like to make a one-time deferral into your Commonwealth of Virginia 457 DCP.

Personal Information Change Request For Inactive Wage/Part-Time Employees

Use this form to change your name and/or marital status.

Self-Certification Unforeseeable Emergency Withdrawal Application - COV 457 Deferred Compensation Plan

Use this form to review the guidelines and request a withdrawal of funds due to an unforeseeable emergency.

Self-Certification Unforeseeable Emergency Withdrawal Application - Hybrid Plan Defined Contribution

Use this form to review the guidelines and request a withdrawal of funds due to an unforeseeable emergency.

Standard Catch-up Form - COV 457

Download this packet to use the Standard Catch-Up feature available in the Commonwealth of Virginia 457 Deferred Compensation Plan.

State Health Benefits Program Enrollment Form for Retirees, Survivors and LTD Participants (A10741)

Unforeseeable Emergency Withdrawal Application - COV 457 Deferred Compensation Plan

Use this form to review the guidelines and request a withdrawal of funds due to an unforeseeable emergency.

Unforeseeable Emergency Withdrawal Application - Hybrid Plan Defined Contribution

Use this form to review the guidelines and request a withdrawal of funds due to an unforeseeable emergency.

Uniform Service Leave Make-up Form - COV 457

Use this form if you served in the military, returned to the workforce and are making additional contributions under USERRA.

Uniform Service Leave Make-up Form - Hybrid Plan Defined Contribution

Use this form if you served in the military, returned to the workforce and are making additional contributions under USERRA.

VRS Life Insurance Forms/Securian Financial

Access forms for VRS-31, VRS-32, VRS-35, VRS-37, VRS-38, VRS-39, VRS-39A, VRS-39R and VRS Certificate of Life Insurance.

VRS-15: Request for Income Tax Withholding

Use this form to request or make changes to your income tax withholding.

VRS-170: Authorization of Coverage Retention for the Long-Term Care Plan (VSDP or VLDP)

Use this form to elect the continuation of your long-term care coverage and to choose how you will pay for this coverage.

VRS-171: VRS Protection Against Unintentional Lapse of Long-Term Care

Use this form to ensure you receive written notice if your long-term care coverage is about to terminate because you have not paid required premium (VSDP or VLDP).

VRS-2: VRS Beneficiary Designation-Defined Benefit

Update beneficiaries online through your secure myVRS account. Note: You must also name beneficiaries for your defined contribution account(s) with Voya.

VRS-26: Application for Purchase of Prior Service Credit

Use this application to initiate purchase of service that your current employer cannot certify.

VRS-26C: Authorization for After-Tax Payroll Deduction to Purchase Service Credit

Log in to myVRS to select payment agreement type and then provide the confirmation details page to your employer.

VRS-26E: Agreement for Pre-Tax Salary Reduction to Purchase Service Credit

Log in to myVRS to select payment agreement type and then provide confirmation details page to your employer.

VRS-3: Request for Refund

Log in to myVRS to submit your refund request.

VRS-3A: VRS Name and Address Declaration for Deferred Members

Use this form to notify VRS of your mailing address when you leave a VRS-covered position and are not taking a refund of your VRS member contribution account.

VRS-3ORP: Request to Transfer of Funds to ORP

Complete this form to request a transfer of your VRS Defined Benefit Plan contributions and interest to your Optional Retirement Plan.

VRS-5: Application for Service Retirement

Before completing the form, log in to myVRS at myvrs.varetire.org/login for retirement counseling resources and review the Apply for Retirement page to determine if you can retire online.

VRS-65D: Termination Certification Form (ORPHE)

Use this form to certify your employment status after terminating your Optional Retirement Plan employment.

VRS-65E: Termination Certification Form (ORPPA)

Use this form to certify your employment status after terminating your Optional Retirement Plan employment.

VRS-70: Request for Review of Membership Records

Use this form if you determine the information on your Member Benefit Profile is inaccurate.

VRS-71B: Termination Certification Form (ORPSS)

Use this form to certify your employment status after terminating your Optional Retirement Plan employment.

VRS-7ORP: Notice of Return to Covered Employment (ORPHE, ORPPA, ORPSS, VSRP)

Complete this form when you return to a position covered under VRS.

VRS-900: Authorization to Discuss VRS Account Information

Use this form to allow VRS representatives to speak to the individual(s) you list regarding your benefits under VRS and your account information.

VRS-901: Durable Power of Attorney

Use this form to create a durable power of attorney by appointing designated agent(s) to make retirement system-related decisions on your behalf.

Wage/Hourly Participant Enrollment Form - COV 457

Use this form to enroll in the Commonwealth of Virginia 457 Deferred Compensation Plan only if you are a wage/hourly employee and not benefit-eligible.

Workforce Transition Act (WTA) Distribution/ Rollover Request Form

Use this form if you have separated employment and are receiving benefits under WTA.