Only for use by Employers that submit paper transmittals.
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.
Return this form to PERSI.
You may make voluntary contributions to the Choice 401(k) Plan. To begin contributions, return this form to your Payroll Clerk.
This worksheet is provided to assist you with the investment allocation of your Choice 401(k) Plan account. Print it out, fill it in and use it when you make changes to your account then keep it as a record of your selections.
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.
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.
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.

Helping Idaho Public Employees Build A Secure Retirement

PERSI Retiree Forms

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.

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. Mouseover the Information Icon icon to view specific instructions for the form. If the Online Icon icon is available, you can submit the form online.

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 Retirees PDF Online
RS110 Address Change
Download PDF Form
Submit Form Online
RS111 Member Name Change
Download PDF Form
Submit Form Online
RS113 PERSI durable Power of Attorney
Download PDF Form
 
RS115 Beneficiary Designation
Download PDF Form
Submit Form Online
RS160 Sick Leave Deduction Authorization
Download PDF Form
Submit Form Online
RS162 Public Safety Officer Authorization for Insurance Premium Deduction
Download PDF Form
 
RS322 Federal and Idaho State Tax Withholding Selection
Download PDF Form
Submit Form Online
RS448 Direct Deposit Authorization
Download PDF Form
Submit Form Online
RS451 Release of Information
Download PDF Form
 
RS451A Release of Account Information By Spouse or Former Spouse
Download PDF Form
 
RS430 Retired Public Safety Officer Insurance Carrier Agreement
Download PDF Form
 
RS802 Choice 401(k) Plan Investment Election Worksheet
Download PDF Form
 
RS803 Request to Contribute Rollover Funds to the Choice 401(k) Plan
Download PDF Form
 
RS813 Choice 401(k) Plan Request for Installment Payments
Download PDF Form