Forms Listed by Number

• KPERS-1, Report of Member Status, Revised 12/06 (PDF, 100KB)
• KPERS-1R, Report of Employment for KPERS Retirees, Revised 6/06 (Excel, 43KB)
• KPERS-1C, School Employee - Certification of Concurrent Employment, Revised 4/06 (PDF, 50KB)
• KPERS-2, Designation of Agent, Revised 7/07 (PDF, 251KB)
• KPERS-2A, Additional Employer Web Portal Access,
  Revised 8/07 (PDF, 249KB)
• KPERS-2B, Change of Employer Contact Information,
  Revised 7/07 (PDF, 193KB)
• KPERS-3, Elected Official Irrevocable Election of Membership (non-legislative), Revised 3/99 (PDF, 38KB)
• KPERS-3A, KPERS Membership and Death and Disability Coverage (for Legislators), Revised 10/07 (PDF, 308KB)
• KPERS-3KD, Election of Deferred Compensation Plan, Revised 3/99
  (PDF, 35KB)
• KPERS-3R, Election of Deferred Compensation Plan for KPERS Retirees (Legislators) KPERS-3R, revised 12-06 (PDF, 73KB)
• KPERS-3TK, Election of Continuation of KPERS Membership or TIAA-CREF Assistance, Revised 3/01 (PDF, 46KB)
• KPERS-4, Election to Remain in the Board of Regents Retirement Plan During a Leave of Absence while Serving in the Kansas Legislature, Revised 8/01 (PDF, 35KB)
• Substitute W-4P, Withholding Certificate for Pension Benefit Payments
  revised 1/08 (PDF, 163KB) - simplified version of IRS W-4P
• IRS W-4P, Internal Revenue Service Withholding for Pension Payments form (PDF, 277KB)
• IRS W-4, (For Disability Recipients) Employee's Withholding Allowance Certificate (link to www.irs.gov)
  
• KPERS-7/99, Designation of Beneficiary, Revised 7/06 (PDF, 39KB)
  
• KPERS-7/99R, Designation of Beneficiary - Retired, Revised 3/08
  (PDF, 330KB)
• KPERS-7/99A, Designation of Beneficiary for Life Insurance - Board of Regents , Revised 6/08 (PDF, 387KB)
• 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.
• KPERS-10, Employer Certification of Service, Revised 7/99 (PDF, 45KB)
• KPERS-10LR, Certification of Legislative Service (For Session Employees), Revised 1/99 (PDF, 24KB)
• KPERS-12, Request for Member Information Change, Revised 2/08
  (PDF, 200KB)
• KPERS-13 Booklet, Application for Withdrawal of Contributions and Related Forms, Revised 7/07 (PDF, 740KB) – Available in print
• KPERS-13, Withdrawal of Contributions, (Form Only) Revised 7/07 (PDF, 338KB)
• KPERS-15 Booklet, Application for Retirement Benefits and Related Forms,
  Revised 7/07 (PDF, 873KB) – Available in print
• KPERS-15, Application for Retirement Benefit, (Form Only) Revised 7/07 (PDF, 307KB)
• KPERS-15B, Direct Deposit - Agreement for Payment of Benefit to Financial Institution, Revised 11/07 (PDF, 257KB)
• KPERS-15E, Retirement Benefit Estimate Request, Revised 2/06
  (PDF, 35KB)
• KPERS-15S, KPERS Retiree Earnings Limitation Form, Revised 5/06
  (PDF, 19KB)
• KP&F-15S, KP&F Retiree Earnings Limitation Form, Revised 5/06
  (PDF, 49KB)
• KPERS-17 EPD, Arrearage Adjustment to Prior Contribution Report -- Employer Paid, Revised 7/04 (PDF, 43KB)
• KPERS-17 OPT, Arrearage/Refund Adjustment to Prior Contribution Report, Revised 4/07 (PDF, 75KB)
• KPERS-17 Table, Arrearage Adjustment Factor Table, Revised 1/08
  (PDF, 121KB), Word doc
• KPERS-32, Request for Retirement Prior to the End of the School Year, Revised 3/99 (PDF, 28KB)
• Important Tax Information Booklet, Revised 12/05 (PDF, 66KB)
• KPERS-40AH, Affidavit of Heirship, Revised 4/08 (PDF, 212KB)
• KPERS-40DOB, Date of Birth Affidavit, Revised 5/08 (PDF, 169KB)
• KPERS-40NC, Name Change Affidavit, Revised 5/08 (PDF, 169KB)
• KPERS-60, Employer's Report of Disability, Revised 9/07
  (PDF, 339KB)
• KPERS-61, Employer's Report of Death, Revised 10/07
  (PDF, 374KB)
• KPERS-67, Application to Purchase Service Credit , Revised 11/07
  (PDF, 348KB)