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| Recent Form Revisions |
- KP&F Employer's Report of Death
KP&F-561, revised 10/09 (PDF, 91KB)
- Application for Withdrawal of Contributions, Related Forms and Information
KPERS-13 Booklet, revised 9/09 (PDF, 466KB) – Available in print
- Request for Member Information Change
KPERS-12, revised 8/09 (PDF, 196KB)
- Application for Retirement Benefits, Related Forms and Information
KPERS-15 Booklet, revised 6/09 (PDF, 563KB) – Available in print
- Direct Deposit - Agreement for Payment of Benefit to Financial Institution
KPERS-15B, revised 6/09 (PDF, 133KB)
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Active Members
Beneficiary Designation
Disability
Elected Officials and Legislators
- Elected Official Irrevocable Election of Membership (non-legislative)
KPERS-3, revised 3/99 (PDF, 38KB)
- KPERS Membership and Death and Disability Coverage (Legislators)
KPERS-3A, revised 10/08 (PDF, 308KB)
- Election of Deferred Compensation Plan
KPERS-3KD,
revised 3/99
(PDF, 35KB)
- Election of Deferred Compensation Plan for KPERS Retirees (Legislators)
KPERS-3R, revised 12-06 (PDF, 73KB)
- Election to Remain in the Board of Regents Retirement Plan During
a Leave of Absence while Serving in the Kansas Legislature
KPERS-4,
revised
8/01 (PDF, 35KB)
Life Insurance
Personal Information
Retirement
- Application for Retirement Benefits, Related Forms and Information
KPERS-15 Booklet, revised 6/09 (PDF, 563KB) – Available in print
- Direct Deposit - Agreement for Payment of Benefit to Financial Institution
KPERS-15B, revised 6/09 (PDF, 133KB)
- Retirement Benefit Estimate Request
KPERS-15E, revised 2/06
(PDF, 35KB)
- Request for Retirement Prior to the End of the School Year
KPERS-32, revised 3/99 (PDF, 28KB)
- Date of Birth Affidavit
KPERS-40DOB, revised 5/08 (PDF, 169KB)
- Name Change Affidavit
KPERS-40NC, revised 5/08 (PDF, 169KB)
Service Credit Purchase
- Application to Purchase Service Credit
KPERS-67, revised 11/07
(PDF, 348KB)
- Application to Purchase Service Credit – Non-KPERS
KPERS-67PS, revised 5/08 (PDF, 409KB)
- Application to Purchase Service Credit – Judges
KPERS-67J, revised 11/07 (PDF, 398KB)
- Service Credit Purchase via Rollover
KPERS-67R, revised 7/07 (PDF, 180KB)
- Service Credit Purchase With a Trustee-to-Trustee Transfer
KPERS-67T, revised 3/07 (PDF, 61KB)
Withdrawal of Contributions
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Retired Members
Beneficiary Designation
Benefit Payments
Personal Information
- Change of Address Form for Retired and Inactive Members
KPERS-700I, revised 10/01 (PDF, 33KB) - Name Change Affidavit
KPERS-40NC, revised 5/08 (PDF, 169KB)
- Authorization to Release Information
KPERS-14, revised 3-09 (PDF, 156KB)
Working After Retirement
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Beneficiaries
Beneficiary Designation
Applying for Death Benefits
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Employers
Death or Disability
Designated Agent
- Designation of Agent
KPERS-2, revised 7/07 (PDF, 251KB) - used to authorize individual staff members to conduct business with the Retirement System.
- Additional Employer Web Portal Access
KPERS-2A, revised 3/09 (PDF, 164KB) - used to authorize employer web portal access. Designated agents and additional signers automatically have full access.
- Change of Employer Contact Information
KPERS-2B, revised 7/07 (PDF, 193KB) - used to update current employer, designated agent or additional signer contact information.
Electronic Funds Transfer
Employment Information
- Report of Member Status
KPERS-1, revised 4/09 (PDF, 258KB)
- Report of Employment for KPERS Retirees,
Please report new retiree employment under "Enrollments" on the employer web portal.
- Election of Continuation of KPERS Membership or TIAA-CREF Assistance KPERS-3TK, revised 3/01 (PDF, 46KB)
- Employer Certification of Service
KPERS-10, revised 7/99 (PDF, 45KB)
- Certification of Legislative Service (For Session Employees)
KPERS-10LR, revised 1/99 (PDF, 24KB)
- Request for Member Information Change
KPERS-12, revised 8/09 (PDF, 196KB)
Life Insurance
Publications
Refunds and Arrearages
Retirement
Schools
Withdrawal of Contributions
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Kansas Police and Firemen's Retirement
System (KP&F)
Death and Disability
Working After Retirement
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Inactive Members
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