PSPRS Online Services:

Active – Inactive – DROP Members

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PSPRS provides quick and easy access to the forms and resources that you may need as a member of one of our plans.  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 retire, 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

Arizona Revised Statutes

PSPRS
CORP
EORP

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

EORP

EODCRS Summary of Plan Provisions

EORP

EORP Administrative Hearing Procedures

EORP

EORP Retirement Excel Spreadsheet Estimator

EORP

Matrix of Plan Provisions

PSPRS
CORP

Member Handbooks

PSPRS
CORP
EORP

PS-CORP Retirement Estimate Form

PSPRS
CORP

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

PSPRS
CORP

Summary of Plan Provisions

PSPRS
CORP
EORP

Membership Forms

Application to Contribute During Industrial Leave (Form 19)

PSPRS
CORP

CORP Request to Remain in ASRS (Form C21)

CORP

CORP Request to Remain in CORP (Form C20)

CORP

EODCRS Nationwide Enrollment Form

EORP

EORP Request to Not Participate in EORP (Form E20)

EORP

Common Change Forms

2024 A-4P – Arizona Voluntary Income Tax Withholding for Pension Payments

PSPRS
CORP
EORP

2024 W-4P – Federal Tax Withholding (3 pages)

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

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

PSPRS
CORP
EORP

Refunds

Complete Refund Packet (12 pages)

PSPRS
CORP
EORP

Direct Deposit Authorization for REFUNDS (Form 13 – Refunds) (optional)

PSPRS
CORP
EORP

Lump Sum Distribution Form for REFUNDS (Form U3 – Refunds) (2 of 2 required docs)

PSPRS
CORP
EORP

Refund Application (P6, C6, E6) (1 of 2 required docs)

PSPRS
CORP
EORP

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

PSPRS
CORP
EORP

Special Tax Notice Regarding Plan Payments

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

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

Safe Harbor Information Sheet / Taxation of Pension Amounts

PSPRS
CORP
EORP

Special Tax Notice Regarding Plan Payments

PSPRS
CORP
EORP

Health Insurance

2024 ASRS Non-Medicare and Medicare Enrollment Guide

PSPRS
CORP
EORP

2024 Dental Enrollment Form

PSPRS
CORP
EORP

2024 Medical Enrollment Form

PSPRS
CORP
EORP

Cancer Insurance and HIPAA Forms

2024 A-4 (Arizona) and W-4 Federal Tax Withholding Forms (2 of 4 required docs)

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 Attending Physician Statement (3 of 4 required docs)

PSPRS
CORP
EORP

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 Claim Form (1 of 4 required docs)

PSPRS
CORP

PSPRS and CORP Cancer Insurance INITIAL PACKET (8 pages)

PSPRS
CORP

PSPRS and CORP Cancer Insurance List of Prescribed Medications (4 of 4 required docs)

PSPRS
CORP
EORP

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

PSPRS
CORP