Forms

Browse the most current versions of the insurance and retirement benefits forms.

Insurance

A-C
D-F
G-P
Q-S
T-Z
Accounting
Affordable Care Act (ACA)
COBRA
Dental care
Employer
Health insurance
Life insurance
Long term disability
MoneyPlus
Notice of election
Other forms
Prescription benefits
Vision care

Retirement

0-9
A-C
D-F
G-P
Q-S
T-Z
1000 Series
  • 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) Notice of Termination or Change
  • 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
2000 Series
  • 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
3000 Series
  • 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
4000 Series
  • 4101  Refund Request (South Carolina Retirement System, Police Officers Retirement System)
  • 4257  Certification of Nonexistent Trust (All Systems)
6000 Series
  • 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
7000 Series
  • 7100  48-Month Rule Request to Terminate Benefits and Return to Active Service
  • 7101  Request for 48-Month Rule Eligibility
  • 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
  • 7214  School Resource Officer Critical Needs Certification
  • 7217  Termination of Retired Member Working Under Earnings Limit
  • 7218  12-Month Break-in-Service Exemption Certification
  • 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 benefit Account (JSRS) Payout Form
Death
Employer
Enrollment
GARS
Installment
JSRS
Leaving covered employment
PORS
Public safety
Refund
Retirement - disability
Retirement - service
Returning to covered employment
SCRS
Service purchase
State ORP
Trust certification