PERSI Forms :. Public Employee Retirement System of Idaho

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PERSI Retiree Forms

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.

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 401(k) Plan 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 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.

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 icon to view specific instructions for the form. If the 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
RS111 Member Name Change
RS113 PERSI durable Power of Attorney
RS115 Beneficiary Designation
RS121R Reinstatement of Retirement
RS160 Sick Leave Deduction Authorization
RS162 Public Safety Officer Authorization for Insurance Premium Deduction
RS322 Federal and Idaho State Tax Withholding Selection
RS448 Direct Deposit Authorization
RS451 Release of Information
RS430 Retired Public Safety Officer Insurance Carrier Agreement
RS803 Request to Contribute Rollover Funds to the Choice 401(k) Plan Choice 401(k) Plan Acceptance Letter
RS813 Choice 401(k) Plan Request for Installment Payments