PSPRS Online Services:

Forms and Resources

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Forms and resources for members, retirees, employers and local boards

PSPRS provides quick and convenient access to the forms and resources needed by members, employers and local boards of the Public Safety Personnel Retirement System (PSPRS), the Corrections Officer Retirement Plan (CORP), the Elected Officials’ Retirement Plan (EORP) and the Elected Officials Defined Contribution Retirement System (EODCRS). All forms and resources are available to view, download or print in PDF format.

Important information about submitting forms:

  • Double-check all fields and required signatures before submitting (Electronic signatures are not accepted; incomplete forms will result in processing delay)
  • Read and follow all directions for submitting completed forms to PSPRS
  • Download forms for immediate use from this page in order to avoid completing and submitting older versions forms that may have been revised
  • Retirement forms must be submitted by the 10th of each month in order to ensure pension benefits can be distributed that month
  • For health insurance enrollment form deadlines, please see the health insurance webpages for PSPRS, CORP or EORP retirees
  • To protect account security, PSPRS cannot accept changes such as name, address, beneficiary, email, tax or direct deposit updates over the phone
  • Always keep a copy of any form you submit for your personal records.

By following these steps, members, retirees, employers, and local boards can ensure timely and accurate processing of all requests.

Resources

Arizona Revised Statutes

PSPRS
CORP
EORP

Elected Officials’ Defined Contribution Retirement System (EODCRS) Plan Overview

EORP

EODCRS Summary of Plan Provisions

EORP

Matrix of Plan Provisions

PSPRS
CORP

Member Handbooks

PSPRS
CORP
EORP

Public Safety Personnel Defined Contribution Retirement Plan (401(a)) Plan Overview

PSPRS
CORP

Public Safety Personnel Defined Contribution Retirement Plan (PSPDCRP) Plan Document

PSPRS
CORP

Summary of Plan Provisions

PSPRS
CORP
EORP

Common Change, Beneficiary and Tax Forms

Address & Name Change (Form 9)

PSPRS
CORP
EORP

Beneficiary Designation (Form 8)

PSPRS
CORP
EORP

Direct Deposit Authorization for RETIRED Members (Form 13)

PSPRS
CORP
EORP

DROP Beneficiary Designation (Form P8 DROP)

PSPRS

FORM U3 Beneficiary Lump Sum Distribution Election Form

PSPRS
CORP
EORP

PS DROP & CORP Reverse DROP Rollover Acknowledgement (for Primary Members only)

PSPRS
CORP

Special Tax Notice Regarding Plan Payments

PSPRS
CORP
EORP

Tax Form – 2025 A-4P-Arizona Voluntary Income Tax Withholding for Pension Payments

PSPRS
CORP
EORP

Tax Form – 2025 W-4P-Federal Tax Withholding (3 pages)

PSPRS
CORP
EORP

Member Forms

CORP Request to Remain in ASRS (Form C21)

CORP

CORP Request to Remain in CORP (Form C20)

CORP

PS-CORP Retirement Estimate Form

PSPRS
CORP

Safe Harbor Information Sheet / Taxation of Pension Amounts

PSPRS
CORP
EORP

Service Purchase/Transfer

Application to Calculate Severance Refund Repayment with Same Employer (Form 1B)

PSPRS
CORP
EORP

Application to Purchase Active Military Service (Form 18)

PSPRS
CORP
EORP

Application to Redeem Prior Service within Same Retirement System (Form 2)

PSPRS
CORP
EORP

Application to Redeem Time with an AZ Public Safety Employer Prior to Joinder Date (Form Pre-Joinder)

PSPRS
CORP

Application to Transfer or Redeem Service Credits Between Arizona Retirement Plans and Municipal Retirement Systems (Form U2)

PSPRS
CORP
EORP

Out of State Service Affidavit (Employee) (Form OSS)

PSPRS
CORP
EORP

PSPRS Affidavit to Redeem Prior Rural Metro Contract Service (Form P2A)

PSPRS

Service Purchase Estimator (does not apply to a transfer)

PSPRS
CORP
EORP

Refunds

Complete Refund Packet (10 pages)

PSPRS
CORP
EORP

Refund form for EX-SPOUSE (Form U3 – Refunds)

PSPRS
CORP
EORP

Employers and Local Boards

ACH Authorization Form

PSPRS
CORP
EORP

Application to Contribute During Industrial Leave (Form 19)

PSPRS
CORP

CORP Employee ANNUAL ENROLLMENT Cancer Insurance Form

CORP

CORP Employee NEW HIRE Cancer Insurance Enrollment Form

CORP

CORP Employer Cancer Insurance Enrollment Form

CORP

CORP Employer Cancer Insurance Terms of the Plan

CORP

CORP New Hire Notification Form for ALL Membership Positions

CORP

CORP Retirement Spreadsheet w/ Membership Date AFTER 1/1/2012 – Tier 2

CORP

CORP Retirement Spreadsheet w/ Membership Date PRIOR TO 1/1/2012 – Tier 1

CORP

CORP Reverse DROP Lump Sum Estimator w/ Membership Date AFTER 1/1/2012 – Tier 2

CORP

CORP Reverse DROP Lump Sum Estimator w/ Membership Date PRIOR TO 1/1/2012 – Tier 1

CORP

CORP Reverse DROP w/ Membership Date AFTER 1/1/2012 – Tier 2

CORP

CORP Reverse DROP w/ Membership Date PRIOR TO 1/1/2012 – Tier 1

CORP

Employer Request for Subsidy (Form ER SUB)

PSPRS
CORP
EORP

Employer Requests to Re-amortize Unfunded Liabilities Policy

PSPRS
CORP
EORP

EODCRS Nationwide Enrollment Form

EORP

EORP Request to Not Participate in EORP (Form E20)

EORP

EORP Retirement Excel Spreadsheet Estimator

EORP

Local Board Member and Employer Information Update (REVISED)

PSPRS
CORP

Local Board Oath of Office

PSPRS
CORP

Local Board Retirement Manual

PSPRS
CORP

Model Uniform Rules of Local Board (REVISED)

PSPRS
CORP

PSPRS and EORP Membership Forms

PSPRS
EORP

PSPRS DROP Spreadsheet w/ Membership Date PRIOR TO 1/1/2012 – Tier 1

PSPRS

PSPRS Retirement Spreadsheet w/ Membership Date AFTER 1/1/2012 – Tier 2

PSPRS

PSPRS Retirement Spreadsheet w/ Membership Date PRIOR TO 1/1/2012 – Tier 1

PSPRS

Health Insurance

2026 ASRS Non-Medicare and Medicare Enrollment Guide

PSPRS
CORP
EORP

2026 Dental Enrollment Form

PSPRS
CORP
EORP

2026 Medical Enrollment Form

PSPRS
CORP
EORP

Cancer Insurance and HIPAA Forms

Cancer Insurance Policy Program Informational Flyer

PSPRS
CORP

HIPAA – Authorization for Use and Disclosure of PHI (not required for packet or claims)

PSPRS
CORP

HIPAA – Privacy Complaint Form (not required for packet or claims)

PSPRS
CORP

HIPAA – PSPRS Notice of Privacy Practice

PSPRS
CORP

HIPAA – Request for Access to Electronic Health Record (EHR) (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 Accounting of Disclosures of PHI (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

PSPRS and CORP Cancer Insurance Combined-Supplemental and Pharmacy Benefits claim form (used after Initial Claim is filed)

PSPRS
CORP

PSPRS and CORP Cancer Insurance INITIAL PACKET (3 pages)

PSPRS
CORP

PSPRS and CORP Plan Description and Schedule of Benefits (2024-01-01)

PSPRS
CORP

Misc. Forms

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 C16 – CORP)

CORP

Return to Work (RTW) Acknowledgment (Form P16 – PSPRS)

PSPRS