Forms
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Designation of Beneficiary KPERS-7/99, (PDF, 257KB) |
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Designation of Beneficiary - Spanish KPERS-7/99SPAN, (PDF, 243KB) |
| Designation of Beneficiary for Life Insurance - Board of Regents KPERS-7/99A, (PDF, 203KB) |
| Additional Beneficiaries - Retirement Benefits Use this form if you have more retirement beneficiaries than space allows on the KPERS-7/99, (PDF, 178KB). |
| Additional Beneficiaries - Life Insurance Benefits Use this form if you have more life insurance beneficiaries than space allows on the KPERS-7/99, (PDF, 180KB). |
| Sheriff's Election of Membership KP&F-503, revised 2/17 (PDF, 118KB) |
| Elected Official Irrevocable Election of Membership (non-legislative) KPERS-3, revised 1/17 (PDF, 151KB) |
| KPERS Membership and Death and Disability Coverage (Legislators) KPERS-3A, revised 12/16 (PDF, 129KB) |
| State Officer Retirement Plan Election
KPERS-3S, revised 12/10 (PDF, 101KB) |
| 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 3/14 (PDF, 132KB) |
| Employee's Withholding Allowance Certificate, IRS W-4 (link to www.irs.gov) |
| KP&F Application for Disability, KP&F-523, (PDF, 54KB) |
| KP&F Physician's Report of Member's Condition, KP&F-538, (PDF, 48KB) |
| Optional Life Insurance - Enrollment Form - Employee, Spouse and Child (PDF, 529KB) |
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| Optional Life Insurance - Reduction or Cancellation KPERS-79, (PDF, 137KB) |
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| Optional Life Insurance - Continuation KPERS-79C, (PDF, 232KB) |
Insurance
Conversion Information and Form The Standard |
| Election of Portable Term Life Coverage The Standard |
Accelerated Death Benefit Claim Form The Standard |
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Application for Retirement Benefits, Related Forms and Information for KPERS 1, KPERS 2, KP&F, Judges KPERS-15 Booklet, revised 4/18 (PDF, 444KB) – Available in print |
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Application for Retirement Benefits for KPERS 3 revised 4/18 (PDF, 444KB) – Available in print |
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New! Solicitud de jubilación (Application for Retirement) KPERS-15Spanish, revised 7/16 (PDF, 491KB) |
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Direct Deposit - Agreement for Payment of Benefit to Financial Institution KPERS-15B, revised 2/17 (PDF, 218KB) |
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Retirement Benefit Estimate Request KPERS-15E, revised 12/17 (PDF, 155KB) |
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Date of Birth Affidavit KPERS-40DOB, revised 6/11 (PDF, 134KB) |
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Name Change Affidavit KPERS-40NC, revised 6/11 (PDF, 200KB) |
| Application to Purchase Service Credit KPERS-67, (PDF, 218KB) |
| Application to Purchase Service Credit – Non-KPERS KPERS-67PS, (PDF, 409KB) |
| Application to Purchase Service Credit – Judges KPERS-67J, (PDF, 398KB) |
| Service Credit Purchase via Rollover KPERS-67R, (PDF, 180KB) |
| Service Credit Purchase With a Trustee-to-Trustee Transfer KPERS-67T, revised 1/13 (PDF, 61KB) |
| Application for Withdrawal of Contributions, Related Forms and Information KPERS-13 Booklet, (PDF, 340KB) - Order printed copy here. |
| Solicitud para Retirar Ahorros de KPERS (Application for Withdrawal), KPERS-13Spanish, (PDF, 227KB) |
| Request for Coronavirus-Related Distribution and Self-Certification , KPERS-19 (PDF, 192KB) |
| Authorization to Release Information KPERS-14, (PDF, 156KB) |
| Important Tax Information Booklet, revised 11/15 (PDF, 195KB) - contains important information about rollover and lump-sum payments. |
| Board Election Affidavit of Petition Circulator (PDF, 49KB) |
| Board Election Candidate Nomination Petition (PDF, 123KB) |
| Designation of Beneficiary - Retired KPERS-7/99R (PDF, 235KB) |
| Additional Beneficiaries - Retirement Benefits (PDF, 178KB) Use this form if you have more retirement beneficiaries than space allows on the KPERS-7/99. |
| Direct Deposit - Agreement for Payment of Benefit to Financial Institution KPERS-15B (PDF, 215KB) |
| Withholding Certificate for Pension Benefit Payments (Substitute W-4P) revised 1/11 (PDF, 218KB) - simplified version of IRS W-4P |
| Internal Revenue Service Withholding for Pension Payments IRS W-4P (link to www.irs.gov) |
Please call KPERS Toll-free at 1-888-275-5737 to report a member's death. We'll provide the necessary form. |
| Change of Address Form for Retired and Inactive Members KPERS-700I (PDF, 128KB) |
| Name Change Affidavit KPERS-40NC (PDF, 169KB) |
| Authorization to Release Information KPERS-14 (PDF, 141KB) |
| KP&F Retiree Earnings Limitation Form KP&F-15S (PDF, 142KB) |
| Designation of Agent KPERS-2 (PDF, 299KB) - used to authorize individual staff members to conduct business with the Retirement System. |
| Retirement Plan Election for Kansas Board of Regents Employees KPERS-3BOR (PDF, 150KB) |
| Employer Certification of Service KPERS-10 (PDF, 186KB) |
| Request for Member Information Change KPERS-12 (PDF, 182KB) |
| Employer Certification of No Prearranged Employment KPERS-15R-E (PDF, 126KB) |
| Optional Group Life Insurance Return to Payroll KPERS-79R (PDF, 130KB) |
| Arrearage Adjustment to Prior Contribution Report – Employer Paid KPERS-17 EPD (PDF, 216KB) |
| Arrearage/Refund Adjustment to Prior Contribution Report KPERS-17 OPT (PDF, 216KB) |
| Arrearage Adjustment Factor Table KPERS-17 Table (PDF, 76KB) |
| Application for Retirement Benefits (Booklet) KPERS-15 (PDF, 330KB) |
| School Employee - Certification of Concurrent Employment KPERS-1C (PDF, 191KB) |
| Application for Withdrawal of Contributions (Form Only) KPERS-13 (PDF, 130KB) |
| Solicitud para Retirar Ahorros de KPERS (Application for Withdrawal) KPERS-13Spanish (PDF, 227KB) |
| Supplemental Form - Withdrawal of Contributions KPERS-101 (PDF, 132KB) |