To correctly view PDF content and reports, please download Adobe Acrobat Reader:  https://get.adobe.com/reader/

PMRS Forms

We are currently in the process of reviewing and updating our forms and are working to increase the usability of each form by making them user-friendly. The term “user-friendly,” in this context, means that a user will be able to type information directly onto the form as accessed from our website.

- Completed Forms can be sent to the following email address: Ra-rscompletedforms@pa.gov
- User-friendly forms are marked below with a checkmark icon:This is a "user-friendly form".  Enter information electronically then print and mail to PMRS.
- For detailed information about each form, press the icon "i" icon: Click this icon below for an explanation of that particular form.

Form/Publication File Size Description Download
Enrollment in Plan & Employee Personal Records
(PMRB-1) Application for Membership
67K  This is a "user-friendly form".  Enter information electronically then print and mail to PMRS.Click for explanation Download
(PMRB-2) Nomination of Beneficiaries
347K Click for explanation Download
(PMRB 5-A) Notification of Change 76K Click for explanation Download
(PMRB-15) Voluntary Contribution Change 35K Click for explanation Download
(PMRB-26) Portability 12K Click for explanation Download
Termination of Employment Other Than By Death
(PMRB-4) Application For Return Of Contributions 454K Click for explanation Download
(PMRB-6) Lump-Sum Distribution Supplement 344K Click for explanation Download
(PMRB-8) Application For Retirement Benefits 216K Click for explanation Download
(PMRB-40) DROP - Deferred Retirement Option Plan 45K This is a "user-friendly form".  Enter information electronically then print and mail to PMRS.Click for explanation Download
(PMRB-44) DROP - Deferred Retirement Option Plan 45K This is a "user-friendly form".  Enter information electronically then print and mail to PMRS.Click for explanation Download
(PMRB-50) Retirement Benefits for Plans with Automatic Spouse's Death Benefits 183K Click for explanation Download
Disability Benefits

(PMRB-9) Employer's Statement Concerning Disability
Order this form from your employer or PMRS

Click for explanation Contact Us
(PMRB-10) Applicant's Statement Concerning Disability
Order this form from your employer or PMRS
Click for explanation
(PMRB-11) Disability Retirement Application
Order this form from your employer or PMRS
Click for explanation
(PMRB-17) Medical Report and Review
Order this form from your employer or PMRS
Click for explanation
Money
Direct Deposit of Annuity Payments 112K Click for explanation Download
(PMRB-20) Revenue Transmittal Form 60K This is a "user-friendly form".  Enter information electronically then print and mail to PMRS.  Click for explanation Download
(W-4P) Withholding Certificate for Pension or Annuity Payments 112K This is a "user-friendly form".  Enter information electronically then print and mail to PMRS.  Click for explanation Download
Miscellaneous Forms
(PMRB-21) Quarterly Report Form 48K Click for explanation Download
NEW (PMRB-30) Disclosures 69K Click for explanation Download
(SSA-1945) Statement Concerning Your Employment in a Job Not Covered by Social Security 407K Click for explanation Download
PMRS Standard Investment Managers Advisory Agreement 139K Click for explanation Download

If you have questions or comments regarding our forms
please call 717-787-2065 or email us at ra-staff@pa.gov.