Active Members

Beneficiary Designation

• Designation of Beneficiary
  KPERS-7/99, revised 7/06 (PDF, 39KB)
• Designation of Beneficiary for Life Insurance - Board of Regents
  KPERS-7/99A, revised 7/06 (PDF, 96KB)
• Additional Retirement Beneficiaries
  revised 6/05 (PDF, 135KB) - use this additional page if you have more retirement beneficiaries than space allows on the KPERS-7/99.
• Additional Life Insurance Beneficiaries
  revised 6/05 (PDF, 137KB) - use this additional page if you have more life insurance beneficiaries than space allows on the KPERS-7/99.

Disability

• Employee's Withholding Allowance Certificate
  IRS W-4, (link to www.irs.gov)

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 10/07 (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

• Optional Group Life Insurance Transfer of Coverage
  KPERS-79, revised 9/03 (PDF, 196KB)
• Optional Group Life Insurance Continuation
  KPERS-79C, revised 11/07 (PDF, 317KB)
• Minnesota Life Optional Group Life Insurance Enrollment Form
  revised 9/03 (PDF, 57KB)
• Minnesota Life Insurance Conversion Information and Form
  revised 1/06 (PDF, 169KB)
• Minnesota Life Election of Portable Term Life Coverage
  revised 7/06 (PDF, 74KB)
• Minnesota Life Insurance Accelerated Death Benefit Claim Form
  revised 2/08 (PDF, 33KB)

Retirement

• Application for Retirement Benefits, Related Forms and Information
  KPERS-15 Booklet, revised 7/07 (PDF, 973KB) – Available in print
• Direct Deposit - Agreement for Payment of Benefit to Financial Institution
  KPERS-15B, revised 11/07 (PDF, 257KB)
• 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

• Application for Withdrawal of Contributions, Related Forms and Information
  KPERS-13 Booklet, revised 7/07 (PDF, 740KB) – Available in print
• Important Tax Information Booklet
  revised 6/07 (PDF, 364KB) - contains important information about rollover
  and lump-sum payments.

Retired Members

Beneficiary Designation

• Designation of Beneficiary - Retired
  KPERS-7/99R, revised 3/08 (PDF, 330KB)
• Additional Retirement Beneficiaries
  revised 6/05 (PDF, 135KB) - use this additional page if you have more retirement beneficiaries than space allows on the KPERS-7/99R.

Benefit Payments

• Direct-Deposit Agreement for Payment of Benefit to Financial Institution KPERS-15B, revised 11/07 (PDF, 257KB)
• Withholding Certificate for Pension Benefit Payments (Substitute W-4P)
  revised 1/08 (PDF, 163KB) - simplified version of IRS W-4P
• Internal Revenue Service Withholding for Pension Payments
  IRS W-4P, (PDF, 277KB)
  

Information Change

• 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)

Working After Retirement

• KPERS Retiree Earnings Limitation Form
  KPERS-15S, revised 5/06 (PDF, 19KB)
• KP&F Retiree Earnings Limitation Form
  KP&F-15S, revised 5/06 (PDF, 49KB)

Beneficiaries

Beneficiary Designation

• Designation of Beneficiary - Retired
  KPERS-7/99R, revised 3/08 (PDF, 330KB)
• Additional Retirement Beneficiaries
  revised 6/05 (PDF, 135KB) - use this additional page if you have more retirement beneficiaries than space allows on the KPERS-7/99R.

Applying for Death Benefits

• Application for Retiree Death Benefit – Non-Spouse
  KPERS-35DB-NS, revised 5-07 (PDF, 204KB)
• Application for Retiree Death Benefit – Spouse
  KPERS-35DB-S, revised 1-07 (PDF, 176KB)
• Affidavit of Heirship
  KPERS-40AH, revised 4/08 (PDF, 212KB)
• Important Tax Information Booklet
  revised 12/05 (PDF, 66KB) - contains important information about rollover
  and lump-sum payments.

Employers

Death or Disability

• Employer's Report of Disability
  KPERS-60, revised 9/07 (PDF, 339KB)
• Employer's Report of Death
  KPERS-61, revised 10/07 (PDF, 374KB)

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 8/07 (PDF, 249KB) - 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

• Authorization for Electronic Funds Transfer
  KPERS-EF105, revised 12/07 (PDF, 125KB)

Employment Information

• Report of Member Status
  KPERS-1, revised 12/06 (PDF, 100KB)
• Report of Employment for KPERS Retirees
  KPERS-1R, revised 6/06 (Excel, 43KB)
• 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 2/08 (PDF, 200KB)

Life Insurance

• Optional Group Life Insurance Return to Payroll
  KPERS-79R, revised 11/07 (PDF, 285KB)
• Minnesota Life Insurance Conversion Information and Form
  revised 1/06 (PDF, 169KB)
• Minnesota Life Election of Portable Term Life Coverage
  revised 7/06 (PDF, 74KB)
• Minnesota Life Insurance Accelerated Death Benefit Claim Form
  revised 5/03 (PDF, 33KB)

Refunds and Arrearages

• Arrearage Adjustment to Prior Contribution Report – Employer Paid
  KPERS-17 EPD, revised 7/04 (PDF, 43KB)
• Arrearage/Refund Adjustment to Prior Contribution Report
  KPERS-17 OPT, revised 4/07 (PDF, 75KB)
• Arrearage Adjustment Factor Table
  KPERS-17 Table, revised 1/08 (PDF, 121KB), Word doc

Retirement

• Application for Retirement Benefits (Form Only)
  KPERS-15, revised 7/07 (PDF, 307KB)

Schools

• Report for School Employers
  (Excel, 20KB) - used to collect information about full-time school district employees with no KPERS contributions.
• School Employee - Certification of Concurrent Employment
  KPERS-1C, revised 4/07 (PDF, 50KB)

Withdrawal of Contributions

• Application for Withdrawal of Contributions (Form Only)
  KPERS-13, revised 7/07 (PDF, 338KB)
• Supplemental Form - Withdrawal of Contributions
  KPERS-101, revised 5/00 (PDF, 36KB)