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Employer Forms: View, Print & Order

New: Fill-in Forms
You can now type directly onto a form. OPERS has begun switching its 'print-only' forms to a 'fill-in' format. While most OPERS forms are now fill-in, there are still some which are 'print-only.' The two formats are distinguishable by the 'P' or 'F' icon located directly next to the form name below.

This form is available in the 'print-only' format.

This form is available in the 'fill-in' format. You can type directly onto the form, print it, sign it and send it to OPERS. Or, you can print it out to be completed by hand.

OPERS forms for employers are available for immediate use by clicking on the name of the publication listed below. We encourage you to request forms to be mailed to you if printing a form is not possible. The forms you request will be mailed within 3-5 business days.

All forms are available in PDF format PDF unless otherwise denoted at the form listing. If you have trouble viewing a PDF, then please visit the help page for assistance.

Feedback: Questions About Employer Forms
Please e-mail us with any issues or suggestions for Employer forms. Include your employer name, contact name, phone number and e-mail address.

Select a Form according to its topic:
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Additional Contributions
Quantity Code Form Name Format Revised Info
AAA-T Additional Annuity Deposit-Traditional Pension Plan Contributors 01/2014 Learn More
VOL-MD Voluntary Deposit Form-Member-Directed Plan Participants 01/2014 Learn More
VOL-CO Voluntary Deposit Form-Combined Plan Participants 01/2014 Learn More


Beneficiary Designation
Quantity Code Form Name Format Revised Info
A-3U Designation of Beneficiary for Traditional Pension, Combined and Member-Directed Plans
• Form Instructions
10/2013 Learn More
A-3AA Member Designation of Beneficiary for Additional Annuity Account
• Form Instructions
06/2012 Learn More
A-3MP Designation of Beneficiary for Money Purchase Contributor
• Form Instructions
06/2012 Learn More
DBO-3CO Designation of Beneficiary for Lump Sum Death Benefit: For Combined Plan
• Form Instructions
08/2013 Learn More
DBO-3T Designation of Beneficiary for Lump Sum Death Benefit: For Traditional Pension Plan
• Form Instructions
08/2013 Learn More
GA-3 Designation of Beneficiary of Guaranteed Account by Retiree
• Form Instructions
08/2013 Learn More


Change Requests
Quantity Code Form Name Format Revised Info
F-50 Address/Bank/Name Change Request 03/2011 Learn More


College/Universities Only
Quantity Code Form Name Format Revised Info
A-4ARP Application for a Transfer to an Alternative Retirement Plan (ARP) 03/2006 Learn More
ARP-3 Retirement Plan Election Form 10/2009 Learn More
F-3 Request for Optional Exemption as a Student
• Form Instructions
10/2013 Learn More


Disability
More information regarding the disability program can be found on the Disability Benefits home page and the Employers Page.
Quantity Code Form Name Format Revised Info
DR-4 Report of Employer for Disability Applicant 04/2014 Learn More
DR-VOLREQPUB Volunteer Service with Public Employer Request Form 09/2013 Learn More


Elected Officials
Quantity Code Form Name Format Revised Info
CSH-6 Certification of Denied In-term Salary Increase 04/2005 Learn More


Employer Reporting
Quantity Code Form Name Format Revised Info
E-3 Employer Payment Remittance Advice 12/2008 Learn More
F-103 Employer Request for Return of Unauthorized Contributions 09/2011 Learn More
  4710 For ECS reporting employers, please submit a Report of Retirement Contributions electronically on ECS. For employers who are not registered for ECS, please call Employer Outreach at 888-400-0965 to order more forms. 01/2011
  4710-2 For ECS reporting employers, please submit a Report of Retirement Contributions - Supplemental electronically on ECS. For employers who are not registered for ECS, please call Employer Outreach at 888-400-0965 to order more forms. 01/2011
  4710-3 For ECS reporting employers, please submit a Report of Service Purchase Deductions electronically on ECS. For employers who are not registered for ECS, please call Employer Outreach at 888-400-0965 to order more forms. 01/2011
CONVDOC Conversion Payment Template 10/2011 Learn More
NCL Non-Contributing List 12/2013


Employer Tools
Quantity Code Form Name Format Revised Info
INFO-EE OPERS A Tradition of Strength Employee Infographic 12/2013  
INFO-ER OPERS A Tradition of Strength Employer Infographic 12/2013  
MBREDOFF Educational Offerings for OPERS Members 06/2013  


Membership
Quantity Code Form Name Fillable Revised Info
PED-1ER Independent Contractor/Employee Determination for Employer 01/2013 Learn More
PEDACKN Independent Contractor/Worker Acknowledgment Fill In 09/2013 Learn More
PEDREQ Notice of Right and Request for: Determination for OPERS Membership Print 03/2013 Learn More


New Employee
Quantity Code Form Name Format Revised Info
  A For ECS reporting employers, please submit personal history records electronically on ECS. For employers who are not registered on ECS, please call Employer Outreach at 1-888-400-0965 to order more forms. --- Learn More
F-3 Request for Optional Exemption as a Student
(College/Universities only)

• Form Instructions
10/2013 Learn More


Re-employed Retiree
Quantity Code Form Name Format Revised Info
A-3MP Designation of Beneficiary for Money Purchase Contributor
• Form Instructions
06/2012 Learn More
  A-4MP Lump Sum Money Purchase for Applicants Under Age 65 refund applications are submitted online. Please click here. 4/2011
MP-1 Application For A Money Purchase Payment 08/2011 Learn More


Refunds
Quantity Code Form Name Format Revised Info
A-4 ARP Application for a Transfer to an Alternative Retirement Plan (ARP)
(Colleges/Universities only)
05/2009 Learn More
  A-4CO Combined Plan refund applications are submitted online through MBS. Please direct the member to MBS. 4/2011 Learn More
  A-4MD Member-Directed Plan refund applications are submitted online through MBS. Please direct the member to MBS. 4/2011 Learn More
  A-4MP Lump Sum Money Purchase for Applicants Under Age 65 refund applications are submitted online through MBS. Please direct the member to MBS. 4/2011 Learn More
  A-4T Traditional Pension Plan refund applications are submitted online through MBS. Please direct the member to MBS. 4/2011 Learn More


Retirement
Quantity Code Form Name Format Revised Info
HC-1G Health Care Coverage Application/Waiver of Coverage 12/2013 Learn More
SR-1CO Combined Plan Retirement Application
• Form Instructions
Document list to provide with this form
Print 01/2013 Learn More
SR-1MD Member-Directed Plan Retirement Application
• Form Instructions Document list to provide with this form
Print 01/2013 Learn More
  SR-1T Service Retirement Traditional Plan Application - Traditional retirement applications are submitted online through MBS. Please direct the member to MBS. If the member is combining their time with another retirement system or has questions, please have the member contact OPERS for additional assistance. 10/2012 Learn More
SR-6 Notice of Re-employment of an OPERS Benefit Recipient 09/2012 Learn More
SR-6E Notice of Re-employment of a Retired Elected or Appointed Official to an Elected Position 09/2012 Learn More


Service Credit
Quantity Code Form Name Format Revised Info
AA Certification of Unreported Public Service 05/2004 Learn More
IM-1 Certification of Interrupted Military Service Print 01/2013 Learn More
LOA Certification of Leave of Absence Print 08/2012  
OS-1 Certification of Federal, Out-of-state, or Municipal Service Print 08/2013 Learn More


Posters
Quantity Code Form Name Format Revised Info
2014MAPRET 2014 Map Out Your Retirement Poster 03/2014  


Forms to be mailed to
Please fill out the form below in order to have a form(s) mailed to you. The name and address information you enter will be used exactly as you enter it to create your mailing label, so please be sure to enter the data accurately.

  * required fields
* First Name: MI:
* Last Name:
* Employer Name:
* Street Address:
(Do not use a PO Box)

* City: State:

* Zip:

* Phone:

E-Mail:
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