What type of form do you need?
Forms
Base Plan Account Withdrawal Form
* Do not submit this form until you have terminated all employment with PERSI-covered employers
Choice 401(k) Plan Paycheck Contribution Election
Member Mailing Address Change Form
* If you are still working for a PERSI employer, your address must be updated through your employer’s payroll transmittal.
Member Name Change Form
* If you are still working for a PERSI employer, your name must be updated through your employer’s payroll transmittal.
PERSI Durable Limited Power of Attorney Form
Request For Account Information By Spouse or Former Spouse Form
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.
Forms
Direct Deposit Authorization Form
Federal & Idaho Tax Withholding Form
Member Mailing Address Change Form
* If you are still working for a PERSI employer, your address must be updated through your employer’s payroll transmittal.
Member Name Change Form
* If you are still working for a PERSI employer, your name must be updated through your employer’s payroll transmittal.
PERSI Durable Limited Power of Attorney Form
Request For Account Information By Spouse or Former Spouse 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.
Forms
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
Certification of 8-Month Seasonal Employment Status Form
Certification of Employment of a Retired Bus Driver
Certification of Employment of a Retired Member Form
Certification of Employment of a Retired Public Safety Officer Form
Certification of Employment of a Retired School Teacher or Administrator Form
Certification of Reemployment of a Working Retiree
Employer Certification of Firefighter Status Form
Employer Certification of Police Officer Status Form
Judicial Retiree Sick Leave Submission Form
Optional Retirement Plan ORP Sick Leave Submission Form
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