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