Retired Members

PSPRS provides quick and easy access to the forms and resources that you may need as a retiree.  All forms and resources are available to download or print in PDF format.  Please note that we cannot accept any changes over the phone, for example: name, address, beneficiary, email, taxes and direct deposit.  Most forms may be mailed, faxed or emailed using the information noted on the form.  In some cases, however, the original form must be mailed in to our office, as noted on the form or in the instructions; please pay careful attention. For all forms, double-check all fields and signatures (we cannot accept an electronic signature) and before submitting a form, please make a copy for your records.

PSPRS or CORP Tier 1, 2 or 3 DB Members:

If you are seeking an application to apply for benefits (i.e., Normal Retirement, enter/exit DROP, Survivor, etc.), you will need to contact your local board secretary in order to complete the necessary forms and documents.  The board secretary will guide you in this process. If you are not certain who your local board secretary is, please Contact Us.

EORP Tier 1 and 2 DB Members, plus Tier 3 EODCRS Members Electing a Disability Benefit:

PSPRS is the local board for EORP and EODCRS disability members; therefore, please Contact Us to assist you in the process of your benefits.

All DC and EODCRS Members:

Please contact Nationwide Retirement Solutions for benefit inquiries.

Deadlines: 

For members electing to exit DROP or apply for Survivor benefits, our office will need to have the completed forms on or before the 10th of the month in order to process that same month.  You will want to consult with your local board secretary as there are additional board requirements that will have an impact on this process.  For Health Insurance Enrollment Form deadlines, please see the Health Insurance section under Retiree for the Plan in which you participate, PSPRS, CORP, or EORP

Since the PSPRS manages 3 separate pension Plans (PSPRS, CORP and EORP), it is very important that you select the appropriate retirement Plan forms from the drop-down listing (using the incorrect form could cause a delay in your request).

Resources
PSPRS CORP EORP
Summary of Plan Provisions PSPRS CORP EORP
EODCRS Summary of Plan Provisions EORP
Member Handbooks PSPRS CORP EORP
Arizona Revised Statutes PSPRS CORP EORP
Public Safety Personnel Defined Contribution Retirement Plan (PSPDCRP) Plan Document PSPRS CORP
Common Change Forms
PSPRS CORP EORP
2024 W-4P - Federal Tax Withholding (3 pages) PSPRS CORP EORP
2024 A-4P - Arizona Voluntary Income Tax Withholding for Pension Payments PSPRS CORP EORP
Address & Name Change (Form 9) PSPRS CORP EORP
Beneficiary Designation (Form 8) PSPRS CORP EORP
Direct Deposit Authorization for RETIRED (Form 13) PSPRS CORP EORP
DROP Beneficiary Designation (Form P8 DROP) PSPRS
FORM U3 Beneficiary Lump Sum Distribution Election Form PSPRS CORP EORP
Misc. Forms
PSPRS CORP EORP
Authorization for Release of Information PSPRS CORP EORP
Domestic Relations Order (DRO) Template PSPRS CORP EORP
Power of Attorney (POA) Template (Provided by Maricopa County Superior Court) PSPRS CORP EORP
Public Records Reproduction Request Form PSPRS CORP EORP
Return to Work (RTW) Acknowledgment (Form P16 - PSPRS) PSPRS
Return to Work (RTW) Acknowledgment (Form C16 - CORP) CORP
Special Tax Notice Regarding Plan Payments PSPRS CORP EORP
Safe Harbor Information Sheet / Taxation of Pension Amounts PSPRS CORP EORP
Health Insurance
PSPRS CORP EORP
2024 Medical Enrollment Form PSPRS CORP EORP
2024 Dental Enrollment Form PSPRS CORP EORP
2024 ASRS Non-Medicare and Medicare Enrollment Guide PSPRS CORP EORP
Cancer Insurance Forms
PSPRS CORP EORP
PSPRS and CORP Cancer Insurance INITIAL PACKET (8 pages) PSPRS CORP
PSPRS and CORP Cancer Insurance INITIAL Claim Form (1 of 4 required docs) PSPRS CORP
2024 A-4 (Arizona) and W-4 Federal Tax Withholding Forms (2 of 4 required docs) PSPRS CORP
PSPRS and CORP Cancer Insurance Attending Physician Statement (3 of 4 required docs) PSPRS CORP
PSPRS and CORP Cancer Insurance List of Prescribed Medications (4 of 4 required docs) PSPRS CORP
PSPRS and CORP Cancer Insurance Combined-Supplemental and Pharmacy Benefits claim form (used after Initial Claim is filed) PSPRS CORP
PSPRS and CORP Plan Description and Schedule of Benefits (2024-01-01) PSPRS CORP
HIPAA - PSPRS Notice of Privacy Practices PSPRS CORP
HIPAA - Privacy Complaint Form (not required for packet or claims) PSPRS CORP
HIPAA - Authorization for Use and Disclosure of PHI (not required for packet or claims) PSPRS CORP
HIPAA - Request for Access to PHI (not required for packet or claims) PSPRS CORP
HIPAA - Request for Access to Electronic Health Record (EHR) (not required for packet or claims) PSPRS CORP
HIPAA - Request for Amendment of PHI (not required for packet or claims) PSPRS CORP
HIPAA - Request for Restriction of PHI (not required for packet or claims) PSPRS CORP
HIPAA - Request for Accounting of Disclosures of PHI (not required for packet or claims) PSPRS CORP