Forms and Resources

Member and Retiree Forms

My PERA Account Forms (Login Required)

You can fill out and submit the forms below by logging in to your secure member account. Don’t have an account? Create one today!

Address Change

Online (login required)

Address Change Form (DB Plan, DC Plan, PERAPlus, Life Insurance)

Beneficiary Change

Online (login required)

Beneficiary Change Form (Defined Benefit Plan)

Direct Deposit and Deduction Authorization

Online (login required)

Direct Deposit by Electronic Funds Transfer (EFT) (monthly benefit payments)

Disability

Online (login required)

Disability Program Application

Health Benefits (PERACare)

Online (login required)

Purchasing Service Credit

Online (login required)

Purchasing Service Credit Application

Retirement

Online (login required)

Downloadable PDFs – Browse by Category

The forms below are all available to download and/or print.

401(k) Plan (PERAPlus)

PDFs (downloadable)

401(k) Contribution Authorization Form

PERAPlus 401(k)/457 Plan Participant Employment Termination Notification Form

PERAPlus 401(k) Participant Information Form

457 Plan (PERAPlus)

PDFs (downloadable)

PERAPlus 401(k)/457 Plan Participant Employment Termination Notification Form

PERAPlus 457 Participant Information Form

PERAPlus 457 Plan Special or Sick/Annual Payments Deferral Form

Address Change

PDF (downloadable)

Address Change Form (DB Plan, DC Plan, PERAPlus, Life Insurance)

Authorization to Release Information/Limited Power of Attorney

PDFs (downloadable)

Authorization to Release Financial Information in a Divorce

Authorization to Release Information

Authorization to Use and/or Disclose Personal Health Information (PHI)

Limited Power of Attorney

Beneficiary Change

PDFs (downloadable)

Retiree Named Beneficiary Change Form

Life Insurance Beneficiary Designation Form

Defined Contribution (DC) Plan (PERAChoice)

PDFs (downloadable)

PERAChoice Years 2-5 Change/Transfer Form

PERA DC Plan Participant Information Change Form

Direct Deposit and Deduction Authorization

PDFs (downloadable)

Direct Deposit by Electronic Funds Transfer (EFT) (monthly benefit payments)

Direct Deposit by Electronic Funds Transfer (EFT) for Minors

Authorization for a Credit Union or Bank Deduction

Disability

PDFs (downloadable)

Disability Program Booklet

Divorce/Domestic Relations Orders

PDFs (downloadable)

Domestic Relations Order

Agreement for Domestic Relations Order

Authorization to Release Financial Information in a Divorce

Health Benefits (PERACare)

PDFs (downloadable)

Medicare Card Submission Form

Certification of Previous Health Care Coverage

PERACare Automatic Payment Authorization

PERACare Program Cancellation

PERACare 2026 Enrollment/Change Form – Pre-Medicare Coverage

PERACare 2026 Enrollment/Change Form – Medicare Coverage

PERACare 2026 Enrollment/Change Form – Combination Coverage (Pre-Medicare and Medicare)

HIPAA Disclosure Form

Life Insurance

PDFs (downloadable)

Life Insurance Enrollment Form

Life Insurance Beneficiary Designation Form

Life Insurance Termination of Coverage Form

Member Information Form

PDFs (downloadable)

Member Information Form

Member Information Form – Spanish

Purchasing Service Credit

PDF (downloadable)

Purchasing Service Credit Application

Refund/Rollover Request

PDFs (downloadable)

Refund/Rollover Request

Refund/Rollover Request – Spanish

Tax Considerations for Refunds and Rollovers

Tax Considerations for Refunds and Rollovers – Spanish

Defined Benefit Plan Refund by Direct Deposit

Financial Institution Certification

Form W-4R

Retirement

PDFs (downloadable)

PERA Benefit Structure Retirement Application

PERA Benefit Structure Retirement Application – Spanish

Denver Public Schools (DPS) Benefit Structure Retirement Application

Form W-4P

Colorado State Withholding Form

Colorado State Withholding Form – Spanish

School Certifications (Benefit Contingencies)

PDFs (downloadable)

School Attendance Certification

Summer Eligibility Certification

Non-Traditional School Attendance Certification

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Forms and Resources

Member and Retiree Forms

My PERA Account Forms (Login Required)

Address Change

Beneficiary Change

Direct Deposit and Deduction Authorization

Disability

Health Benefits (PERACare)

Purchasing Service Credit

Retirement

Downloadable PDFs – Browse by Category

401(k) Plan (PERAPlus)

457 Plan (PERAPlus)

Address Change

Authorization to Release Information/Limited Power of Attorney

Beneficiary Change

Defined Contribution (DC) Plan (PERAChoice)

Direct Deposit and Deduction Authorization

Disability

Divorce/Domestic Relations Orders

Health Benefits (PERACare)

Life Insurance

Member Information Form

Purchasing Service Credit

Refund/Rollover Request

Retirement

School Certifications (Benefit Contingencies)

Forms to Apply for Retirement | Quick Tips