Forms

Base Plan Account Withdrawal Form
* Do not submit this form until you have terminated all employment with PERSI-covered employers

Beneficiary Designation Form

Choice 401(k) Plan Paycheck Contribution Election

Member Mailing Address Change Form

Member Name Change Form

PERSI Durable Limited Power of Attorney Form

Release of Information Form

Request For Account Information By Spouse or Former Spouse Form

Retirement Application Kit
* Be sure to include a completed copy of the Federal W-4P Form with your completed Retirement Application Kit.

Social Security Quote Certification

Third-Party Verification Request

* All other Choice 401(k) Plan forms are available by calling Empower Retirement at 1-866-437-3774 or by logging into your Choice 401(k) Plan account. You can log in to your Choice 401(k) Plan account either via the link in your myPERSI account or directly to the Choice 401(k) Plan website.

Beneficiary Designation Form

Direct Deposit Authorization Form

Federal W-4P Tax Withholding Certificate

Member Mailing Address Change Form

Member Name Change Form

PERSI Durable Limited Power of Attorney Form

Release of Information Form

Request For Account Information By Spouse or Former Spouse Form

Retirement Application Kit

State of Idaho Tax Withholding Form

Third-Party Verification Request

* All other Choice 401(k) Plan forms are available by calling Empower Retirement at 1-866-437-3774 or by logging into your Choice 401(k) Plan account. You can log in to your Choice 401(k) Plan account either via the link in your myPERSI account or directly to the Choice 401(k) Plan website.

Online Fill-in Versions

Employer Certification of Police Officer Status Form

Employer Certification of Firefighter Status Form

Judicial Retiree Sick Leave Submission Form

Optional Retirement Plan ORP Sick Leave Submission Form

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Certification of 8-Month Seasonal Employment Status Form RS130

Certification of Employment of a Public Safety Retired Contributing Member RS132F

Certification of Employment of a Retired Bus Driver RS132B

Certification of Employment of a Retired Member Form RS132

Certification of Employment of a Retired Public Safety Officer Form RS132R

Certification of Employment of a Retired School Teacher or Administrator Form RS132A

Certification of Reemployment of a Working Retiree RS131

Employer Certification of Firefighter Status Form RS118A

Employer Certification of Police Officer Status Form RS118

Judicial Retiree Sick Leave Submission Form RS119JR

Optional Retirement Plan ORP Sick Leave Submission Form RS119

PERSI Easy Pay An Electronic Payment System Form

PERSI Employers Forms Version Log Form

Termination of Employment of a Retired School Teacher Administrator or School Resource Officer Form RS132T

Voluntary Employer Sick Leave Submission Form RS119V