Member Forms
Members frequently request the forms listed below. Each form opens in a pdf format, which is good for viewing and printing, although you must have Adobe Reader installed on your computer. Some forms have an online version that you can fill in from your computer and submit electronically.
| Enrollment/Beneficiary Designation Form. Used to enroll new public employees in IPERS, this form also names the beneficiary who would receive your death benefits. It’s critical to keep this information up to date by filing a new form when necessary! |
online | pdf |
| Name or Address Change. Use this form, which is accessible from your online account, to update your name or address. You need to notify IPERS of an address change even if you already notified your employer or the post office. It’s important that you keep your address up to date so IPERS can send important information to you. If you don’t have an online IPERS account, it’s quick and easy to create one. |
online | pdf |
| Application for IPERS Retirement Benefits. Please contact an IPERS retirement counselor to request a copy of this form. The counselor will discuss your options, provide information specific to your situation, and send you the forms you need. |
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| Application for IPERS Refund. Use this form when you have ended covered employment and decided to take a refund. You have other alternatives to a refund, and IPERS recommends you weigh your options carefully before deciding. |
online | pdf |
| Application for Free Military Credit. Use this form if you served in the military and may be eligible for free service credits. |
online | pdf |
| Application for Military Leave Contributions. Use this form if you served in the military and want to make up IPERS contributions that were not paid while you were on active duty. |
online | pdf |
| Application for Service Purchase. Use this form if you are interested in purchasing service as a way to increase your benefit or allow you to retire earlier. |
online | pdf |
| Election for Termination of IPERS Coverage. Public employees and elected officials who can choose between IPERS and another plan use this to elect out of IPERS coverage. This option is not available to all public employees. |
online | pdf |
| Request for IPERS Benefit Estimate. Use this form to obtain a benefit estimate when you are within 3 years of your planned retirement, age 69½ or older, or are retiring because of disability. |
online | pdf |
| Request for Benefit Estimate for Members Affected by a Furlough. If your final average salary would be reduced because of an employer-mandated reduction of work hours, you may be eligible to minimize the negative impact to your IPERS benefit amount by making additional contributions to IPERS. Request a benefit estimate to see how the additional contributions can affect your IPERS benefit amount. |
online | pdf |
| Application to Submit Contributions for Furlough. Members affected by a furlough can choose to make up IPERS contributions. Use this form if you want to submit contributions for furlough. |
online | pdf |
| Model QDRO. A Qualified Domestic Relations Order (QDRO) is a special court order that specifies how pension assets and property will be divided in a divorce. This model QDRO can be used as a template by lawyers and the court to create a QDRO. To learn more about QDROs, please select Benefit Information from the left-hand menu, and choose the topic on Divorce. |
MS Word | pdf |
Authorization for Release of Information. This form authorizes IPERS to release and discuss specified information from a member's IPERS account with another named party. |
online | pdf |
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