Forms

Application For Retirement

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
* 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

Release of Information 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.

Application For Retirement

Beneficiary Designation Form

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

Release of Information 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.

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

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

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

Voluntary Employer Sick Leave Submission Form