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

  • 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
  • 7216   COVID-19 Earnings Limitation Exception 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

SCRS

Service purchase

State ORP

Trust certification