Serving those who serve South Carolina

Forms by number

  • 1000 Series

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    1100 Enrollment Form (All Systems)

    1102 Beneficiary Form - Beneficiary Designation, Contingent Beneficiary (All Systems)

    1103 Beneficiary/Trustee Designation Form (All Systems)

    1104 Election of Non-Membership

    1106 State Optional Retirement Program (ORP) Active Incidental Death Benefit Beneficiary Form (South Carolina Retirement System)

    1107 Employer Certification of Police Officers Retirement System (PORS) Eligibility

    1113 Certification of Trust (All Systems)

    1162 State Optional Retirement Program (State ORP)

    1221 Standard Retirement Quarterly Report (South Carolina Retirement System, Police Officers Retirement System)

    1222 Standard Retirement Quarterly Report - Class I Employer (South Carolina Retirement System, Police Officers Retirement System)

    1223 Adjustment to Quarterly Payroll Report (South Carolina Retirement System, Police Officers Retirement System)

    1224 Supplemental Service Report (South Carolina Retirement System, Police Officers Retirement System)

    1226 ACH Debit Authorization

    1227 Supplemental Contribution Report

    1239 Name/Address Change Form

    1286 EES Electronic Payment Authorization Agreement

    1340 Fiscal Year Contribution Rates

    1341 Due Date Calendar

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    2000 Series

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    2101 Request for Service Purchase Cost (All Systems)

    2122 Request for Public/Educational Service Verification

    2130 Request for ORP Service Verification (Applies to ORP service in South Carolina only.)

    2140 General Assembly Retirement System Special Contributing Member Election

    2209 Service Purchase Salary Verification

    2390 Service Purchase Payment Options (All Systems)

    2391 Service Purchase Federal Address List

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    3000 Series

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    3227A Requirements for a Participant to Revoke Election to Participate

    3228 Employer Resolution on Tax Deferred Payroll Deductions for Installment Purchase

    3229 Installment Service Purchase Remittance

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    4000 Series

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    4101 Refund Request (South Carolina Retirement System, Police Officers Retirement System)

    4257 Certification of Nonexistent Trust (All Systems)

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    6000 Series

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    6100 Request for Retirement Benefit Estimate (All Systems)

    6101G General Assembly Retirement System Application for Service Retirement Benefits

    6101J Judges and Solicitors' Retirement System Application for Service Retirement Benefits

    6101N SCNG Service Retirement Application

    6101P Police Officers Retirement System Application for Service Retirement Benefits

    6101S South Carolina Retirement System Application for Service Retirement Benefits

    6151P Police Officers Retirement System Application for Disability Retirement

    6151S South Carolina Retirement System Application for Disability Retirement

    6251 Member's Disability Report

    6253 Employer's Disability Employment Status Report

    6254 Employer's Description of Disability Applicant's Job

    6255 Authorization For Release of Information

    6291 Administrative Appeal Disability Report

    6302 Retiring Member's Service Application Checklist

    6352 Retiring Member's Disability Applications Checklist

    6500 Employer Eligibility Determination Request

    6501 Employer Resolution And Application (SCRS)

    6501P Employer Resolution And Application (PORS)

    6502 Application to Append Coverage for Incidental Death Benefit (SCRS)

    6502P Application to Append Coverage for Incidental Death Benefit, Accidental Death Program And/Or Firefighters Coverage (PORS)

    6503 Electronic Employer Services (EES) Employer Confidentiality Agreement

    6504 Electronic Employer Services (EES) Authorizing Contact Designation/Agreement

    6505 Electronic Employer Services (EES) Designated Agent Confidentiality Agreement

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    7000 Series

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    7201 Retired Member Change of Beneficiary (South Carolina Retirement System, Police Officers Retirement System)

    7201G Retired Member Change of Beneficiary Form (GARS)

    7202 Withholding Certificate for Monthly Benefit Payments

    7204 Direct Deposit Authorization

    7213 Authorized Representative Form

    7500 Teacher and Employee Retention Incentive (TERI) Payout Election Form

    7700 Deduction Form, Public Safety Officer Insurance Payment Program - EIP Only

    7701 Deduction Form, Public Safety Officer Insurance Payment Program - Non-EIP

    7800 Deferred Annuity Account (JSRS) Payout Form

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Columbia, SC 29223

803.737.6800 | 888.260.9430

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State of South Carolina

S.C. Code of Laws

© 2017 South Carolina Public Employee Benefit Authority

Data classification: public information