PERSI Forms and Publications

Public Employee
Retirement System of Idaho

PERSI Forms and Publications

Forms

Directions

... for Active Members

... for Inactive Members

... for Retired Members

... for FireFighter Retirement Fund (FRF) Members

... for Employers

Other Forms

Handbooks

Member Handbook

FRF Handbook

Brochures

Newsletters

Annual Report

Choice Plan

Guide

Highlights

Print

Order

Directions for DOWNLOADING, PRINTING and COMPLETING PERSI's forms

Here are some of PERSI’s most commonly used forms for active members, retirees and employers. You may download and print copies.

DOWNLOADING : To download the forms, you will need the latest version of ADOBE ACROBAT READER. If you do not have the latest version on your computer, you can download it for free from Adobe:

http://www.adobe.com/products/acrobat/readstep.html

PRINTING : Once you have downloaded the forms, open them in Acrobat Reader. Print as you would any document. If the text seems to be pushed together on your printed document, you may need to adjust your printer settings for the forms to print correctly. Try checking or unchecking the "fit to page" option. Again, make sure you have Adobe Acrobat 4.0 or higher.

COMPLETING FORMS: Some of the forms listed below also have instructions. We strongly suggest you read the instructions before completing the form. This will help ensure that the form is filled out correctly and will speed our fulfillment of your request. Incorrect or incomplete forms often must be returned, causing unnecessary delays for your request.

For all forms, double-check dates, numbers and signatures. This may seem elementary, but you would be surprised how often mistakes are made on the simplest of items. Please double-check the following:

Social Security Number - it is very important that we have your correct Social Security Number. Make sure you haven't transposed numbers, mistakenly filled in a date or phone number, etc.
Name - it is important that we have your name exactly as it is on your Social Security card. We require that name to issue payments.
Dates - make sure you've filled in correct dates (not mistaking birthdates for date of last employment, etc.)
Signatures - make sure all necessary signatures are included. In addition to the member's signature, some forms require a signature from a spouse, Notary Public, or authorized administrative representative.

Before submitting the form, make a copy for your records. Send or deliver the form as directed in the instructions for the form. Some forms go to PERSI, others to the employer, and some go to ACS HR Solutions. Please be careful to send the form to the right place or processing will be delayed.

Other forms may be obtained by calling PERSI at 1-800-451-8228 or 208-334-3365 or by e-mailing Member Services

FORMS FOR ACTIVE MEMBERS
102 - Membership Application	Only for use by Employers that submit paper transmittals.
108 - Request for Base Plan Account Withdrawal 108 - Submit On-Line Special Tax Notice	108 - Base Plan Account Withdrawal Important Information
110 - Address Change	Return this form to your employer's Payroll Clerk. They must update their records as well. Otherwise, when they report to us each month, their "old" data will override our system.
111 - Member Name Change 111 - Submit On-Line	Return this form to PERSI.
113 - PERSI Durable Power of Attorney
115 - Beneficiary Designation 115 - Submit On-Line
116B - Additional Payment Agreement In PDF Format or In Word Format
451 - Release of Information 451 - Submit On-Line
460 - Alternate Date of Birth Evidence
801 - Choice Plan 401(k) Deferral Election Form	You may make voluntary contributions to the Choice Plan 401(k). To begin contributions, return this form to your Payroll Clerk.
803 -Request to Contribute Rollover Funds to the Choice Plan 401(k) Choice Plan 401(k) Acceptance Letter	The Choice Plan accepts rollover contributions from other qualified retirement plans. Instructions and additional information are included with the form to guide you through the process. The Choice Plan 401(k) Acceptance Letter states that the Choice Plan is a qualified retirement plan which will accept your rollover. You can print it and give it to the administrator of your other plan or IRA along with the completed form.
808 Choice Plan 401(k) Request for In-Service (Rollover) Withdrawal	Active members may take a full or partial distribution of their Choice Plan 401(k) “Rollover” sub-account either as a direct payment to them, as a rollover to an IRA or other eligible retirement plan or a combination of the two.
809 Choice Plan 401(k) Request for In-Service Withdrawal of Idaho Super Saver Funds	Active members who are at least 59½ years of age may take full or partial distribution of their “Prior Employee Pre-tax Contribution” sub-account either as a direct payment to them, as a rollover to an IRA or other eligible retirement plan or a combination of the two.
812 Choice Plan 401(k) Request for Hardship Withdrawal	Use this form to request a hardship withdrawal from your eligible Choice 401(k) Plan funds to relieve an immediate and heavy financial need for one or more of the qualifying reasons defined in Section 6.2(c) of the Choice 401(k) Plan articles.
1000 – Retirement Application Kit (RS121, RS322, RS448, RS113, RS115, and RS160)	This is a collection of fill-in forms for members who are applying for retirement. When you fill in the name and address information on the first form (RS121 Retirement Application) the information is copied to the other forms, eliminating the need for repetitive entry. Note! You must contact PERSI for a retirement estimate before completing and submitting these forms.
To request a Choice Plan 401(k) Enrollment Kit, please e-mail us: Request an Enrollment Kit

FORMS FOR INACTIVE MEMBERS
108 - Request for Base Plan Account Withdrawal 108 - Submit On-Line Special Tax Notice	108 - Base Plan Account Withdrawal Important Information
448 - Direct Deposit Authorization 448 - Submit On-Line
110 - Address Change 110 - Submit On-Line 111 - Member Name Change 111 - Submit On-Line	Return this form to PERSI.
113 - PERSI Durable Power of Attorney
115 - Beneficiary Designation 115 - Submit On-Line
451 - Release of Information 451 - Submit On-Line
804 - Choice Plan 401(k) Request for Distribution/Rollover	If you are no longer employed by a PERSI employer, you may receive your funds from the Choice Plan. Refer to the instructions on the form for complete information about a distribution or rollover from your Choice Plan account. The Special Tax Notice included with the form explains the tax consequences of taking a distribution from your retirement plan.
807 - Choice Plan 401(k) Request for Death Benefit Payment	Use this form to certify that you are a beneficiary of a deceased Choice Plan participant and to request payment of the deceased participant’s Choice Plan funds. Instructions and important tax information are included with the form.

FORMS FOR RETIRED MEMBERS
110 - Address Change 110 - Submit On-Line 111 - Member Name Change 111 - Submit On-Line
113 - PERSI Durable Power of Attorney
115 - Beneficiary Designation 115 - Submit On-Line
121R - Reinstatement of Retirement 121R - Submit on line
160 - Sick Leave Deduction Authorization 160 - Submit on line
322 - Federal and Idaho State Tax Withholding Selection 322 - Submit On-Line
448 - Direct Deposit Authorization 448 - Submit On-Line
451 - Release of Information 451 - Submit On-Line
162 - Public Safety Officer Authorization for Insurance Premium Deduction
430 - Retired Public Safety Officer Insurance Carrier Agreement
804 - Choice Plan 401(k) Request for Distribution/Rollover	If you are no longer employed by a PERSI employer, you may receive your funds from the Choice Plan. Refer to the instructions on the form for complete information about a distribution or rollover from your Choice Plan account. The Special Tax Notice included with the form explains the tax consequences of taking a distribution from your retirement plan.
803 -Request to Contribute Rollover Funds to the Choice Plan 401(k) and Choice Plan 401(k) Acceptance Letter	The Choice Plan accepts rollover contributions of retired members who maintained their Choice Plan account after retirement. Rollovers are accepted from other qualified retirement plans. Instructions and additional information are included with the form to guide you through the process. The Choice Plan 401(k) Acceptance Letter states that the Choice Plan is a qualified retirement plan which will accept your rollover. You can print it and give it to the administrator of your other plan or IRA along with the completed form. If you did not maintain your Choice Plan account you may not open an account after retirement.

FORMS FOR FIREFIGHTER RETIREMENT FUND (FRF) MEMBERS

621F - FRF Firefighter Retirement Application
621F - Submit On-Line

FORMS FOR EMPLOYERS
102 - Membership Application	Only for use by Employers that submit paper transmittals.
109 - Notice of Separation or Leave of Absence In PDF Format 109 - Submit On-Line
110 - Address Change
116B - Additional Payment Agreement In PDF Format or In Word Format
118 - Certification of Police Officer Status 118 - Certification of Police Officer Status (Fill-in Version) 118 - Submit On-Line
118a - Certification of PERSI Firefighter Status 118a - Certification of PERSI Firefighter Status (Fill-in Version) 118a - Submit On-Line
130 - Certification of City or County Employee's 8-Month Seasonal Status
132 - Certification of Employment of a Retired Member 132A – Certification of Employment of a Retired School Teacher or Administrator
415 - Request for Premium Payments through the (ORP) Sick Leave Entitlement Program
432C - Insurance Carrier Certification of Group Insurance Policy
432R - Employer Certification of Group Insurance Policy
Easy Pay - PERSI's Electronic Payment System Introduction to Easy Pay and Sign-Up Form
PERSI Forms Version Log

PERSI Member Handbook

PDF version (1 MB) updated 12-2006

To download the Handbook, you will need the latest version of ADOBE ACROBAT READER. If you do not have the latest version on your computer, you can download it for free from Adobe:

http://www.adobe.com/products/acrobat/readstep.html

FireFighter Retirement Fund (FRF) Handbook

Firefighter (FRF) Handbook

PERSpectives Newsletters

2008

Second Quarter Member Newsletter - PERSI Executive Director announces retirement, using an ATM safely, Stake a claim on what's rightfully yours, Regular interest rate set
Second Quarter Retiree Newsletter - PERSI Executive Director announces retirement, using an ATM safely, $40 million in unclaimed property in Idaho
First Quarter Member Newsletter - Customer Service Survey Results, Confused about the Social Security Retirement Option?, New Retirement Workshops Available
First Quarter Retiree Newsletter - Customer Service Survey Results, State of Idaho Taxes and Form 39-R, The Benefits of Physical Activity, Using your Tax Rebate Check

2007

Fourth Quarter Active Member Newsletter - Don't let taxes stress you out...Get organized, Planning for retirement on your 60s and beyond, A rise in interest rates can impact buy backs

Fourth Quarter Retiree Newsletter - Don't let taxes stress you out...Get organized, Understanding your 1099-R, Board approves maximum COLA for retirees.

Third Quarter Retiree Newsletter - A Message for PERSI Members, Hold on to your wallet if you are going to a FREE investment seminar, New Investment Options for the Choice Plan 401(k).

Third Quarter Active Member Newsletter - A Message for PERSI Members, Retirement Planning in your Fifties, New Investment Options for Choice Plan 401(k).

Second Quarter Retiree Newsletter - Financial abuse of the elderly, Keeping your important documents organized, Giving your doctor a check up.

Second Quarter Active Member Newsletter - Retirement Workshops Redesigned, Planning for retirement in your forties, Buying back a separation benefit, Single Log-on available for PERSI Accounts

First Quarter Retiree Newsletter - What your Base Plan beneficiary should know, The benefits of direct deposit, Required minimum distributions begin at age 70.5, Opting out of credit card offers.

First Quarter Active Member Newsletter - When should members get retirement estimate?, Opting out of credit card offers, Planning for retirement twenties thirties, The benefits of making an appointment with PERSI, Smart ways to use your tax refund.

2006

First Quarter Retiree Newsletter - Medicare Beneficiaries: Beware of phone scams, remaining in or returning to the workforce, Senior are exploring reverse mortgages.

First Quarter Active Member Newsletter - Keeping your mailing address current, PERSI welcomes new deputy director, Spring is a good time to review your estate plan, Legislative Updates: Bills affecting PERSI, Working after retirement and your PERSI benefits.

Second Quarter Active Member Newsletter - Time limits for filing for PERSI disability, Contributing to the Choice Plan: You have options, Hey ladies, Do you want a secure retirement?

Second Quarter Retiree Newsletter - Anytime is time to review your estate plan, Identity Theft: What you should know, Agencies on Aging Help Idaho Seniors.

Third Quarter Retiree Newsletter - PERSI web domain and email address change, PERSI Answer Center celebrates anniversary, Making life insurance decisions

Third Quarter Active Member Newsletter - PERSI web domain and email address change, PERSI Answer Center celebrates anniversary, Making life insurance decisions

Fourth Quarter Retiree Newsletter - PERSI Funding Status Among the Highest Nationwide, Contribution Rates and Cost of Living Adjustments, 2007 Financial Resolution Solutions, Beneficiary Form has Changed, Choice Plan 401(k) Statements Available Online, 1099 forms.

Fourth Quarter Active Member Newsletter - PERSI Funding Status Among the Highest Nationwide, Contribution Rates and Cost of Living Adjustments, 2007 Financial Resolution Solutions, Beneficiary Form has Changed, Choice Plan 401(k) Statements Available Online.

PERSI Brochures
Benefits at a Glance
Retirement Planning Check list

BASE PLAN

Tax Deductibility of IRA Contributions (pdf)
Outliving Your Spousal Contingent Annuitant (pdf)

Credited Service

Death Benefits

Disability Benefits (116K pdf)

Divorce and Your PERSI Accounts

Early Retirement

Interest Charged on Base Plan Repayments

Military Service and Your PERSI Benefits (300K pdf)

Mixed Service Retirement

Purchase of Service