Forms By User
KPERS’ forms listed by user
Member Forms
- Designation of Beneficiary
KPERS-7/99,(PDF,257KB) - Nombramiento De Beneficiarios
KPERS-7/99SPAN,(PDF,243KB) - 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)
- Optional Life Insurance - Enrollment Form - Employee, Spouse, and Child
(PDF, 529KB) - Optional Life Insurance - Enrollment Form - KBOR
(PDF, 332KB) - Optional Life Insurance - Reduction or Cancellation
KPERS-79, (PDF, 137KB) - 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
The Standard
- Application for Retirement Benefits, Related Forms and Information
for KPERS 1, KPERS 2, KP&F, Judges
KPERS-15 Booklet, revised 1/23 (PDF, 444KB) - Available in print - Application for Retirement Benefits
for KPERS 3
revised 2/23 (PDF, 444KB) - Solicitud de jubilación
(Application for Retirement)
KPERS-15Spanish, revised 7/16 (PDF, 491KB) - Direct Deposit - Agreement for Payment of Benefit to Financial Institution
Use this form if you have more retirement beneficiaries than space allows on the KPERS-7/99, (PDF, 178KB). - Retirement Benefit Estimate Request
KPERS-15E, revised 12/17 (PDF, 155KB) - Date of Birth Affidavit
KPERS-40DOB, revised 6/11 (PDF, 134KB) - 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 KP&F Deferred Retirement Option Program (DROP)
KP&F-15DROP, (PDF, 150KB) - Application to Extend KP&F Deferred Retirement Option Program (DROP)
KP&F-15DROPEXT, (PDF, 230KB) - Application for KP&F DROP & Monthly Retirement Benefits
KPERS-15DROPDM, (PDF, 150KB) - Designation of Beneficiary - DROP
KP&F-7/99DROP, (PDF, 150KB)
- Application for Withdrawal of Contributions, Related Forms and Information
KPERS-13 Booklet, (PDF, 340KB) - Solicitud para Retirar Ahorros de KPERS (Application for Withdrawal)
KPERS-13 Spanish, (PDF, 227KB)
- Authorization to Release Information
KPERS-14, (PDF, 156KB) - Important Tax Information Booklet
Retiree Forms
- Designation of Beneficiary - Retired
KPERS-7/99,(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) - IRS W-4P form (Withholding Certificate for Periodic Pension or Annuity Payments)
(PDF, leaves KPERS website)
Please call KPERS Toll-free at 1-888-275-5737 to report a retiree's death. We'll provide the necessary form.
- Change of Address Form for Retired and Inactive Members
KPERS-700I (PDF, 128KB) - Authorization to Release Information
KPERS-14 (PDF, 141KB)
- KP&F Retiree Earnings Limitation Form
KP&F-15S, (PDF, 142KB)
Employer Forms
- Designation of Agent
KPERS-2 (PDF, 299KB) - used to authorize individual staff members to conduct business with the Retirement System.
- Employer Certification of Service
KPERS-10 (PDF, 186KB) - Member Payroll Department Change
KPERS-11 (PDF, 206KB) - Request for Member Information Change
KPERS-12 (PDF, 238KB) - 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)
- School Employee - Certification of Concurrent Employment
KPERS-1C (PDF, 191KB)
- Employer Certification of No Prearranged Employment
KPERS-15R-E (PDF, 126KB)