Forms

Browse the most current versions of the insurance and retirement benefits forms.


Insurance

A-C

D-F

G-P

Q-S

T-Z

    Accounting

    Affordable Care Act (ACA)

    COBRA

    Dental care

    Employer

    Health insurance

    Life insurance

    Long term disability

    MoneyPlus

    Notice of election

    Other forms

    Prescription benefits

    Vision care

    Retirement

    A-C

    D-F

    G-P

    Q-S

    T-Z

    1000 Series

    • 1100 Enrollment Form (All Systems)
    • 1102 Beneficiary Form - Beneficiary Designation, Contingent Beneficiary (All Systems)
    • 1103 Beneficiary/Trustee Designation Form (All Systems)
    • 1104 Election of Non-Membership
    • 1106 State Optional Retirement Program (ORP) Active Incidental Death Benefit Beneficiary Form (South Carolina Retirement System)
    • 1107 Employer Certification of Police Officers Retirement System (PORS) Eligibility
    • 1113 Certification of Trust (All Systems)
    • 1162 State Optional Retirement Program (State ORP) Notice of Termination or Change
    • 1221 Standard Retirement Quarterly Report (South Carolina Retirement System, Police Officers Retirement System)
    • 1222 Standard Retirement Quarterly Report - Class I Employer (South Carolina Retirement System, Police Officers Retirement System)
    • 1223 Adjustment to Quarterly Payroll Report (South Carolina Retirement System, Police Officers Retirement System)
    • 1224 Supplemental Service Report (South Carolina Retirement System, Police Officers Retirement System)
    • 1226 ACH Debit Authorization
    • 1227 Supplemental Contribution Report
    • 1239 Name/Address Change Form
    • 1286 EES Electronic Payment Authorization Agreement
    • 1340 Fiscal Year Contribution Rates
    • 1341 Due Date Calendar

    2000 Series

    • 2101 Request for Service Purchase Cost (All Systems)
    • 2122 Request for Public/Educational Service Verification
    • 2130 Request for ORP Service Verification (Applies to ORP service in South Carolina only.)
    • 2140 General Assembly Retirement System Special Contributing Member Election
    • 2209 Service Purchase Salary Verification
    • 2390 Service Purchase Payment Options (All Systems)
    • 2391 Service Purchase Federal Address List

    3000 Series

    • 3227A Requirements for a Participant to Revoke Election to Participate
    • 3228 Employer Resolution on Tax Deferred Payroll Deductions for Installment Purchase
    • 3229 Installment Service Purchase Remittance

    4000 Series

    • 4101 Refund Request (South Carolina Retirement System, Police Officers Retirement System)
    • 4257 Certification of Nonexistent Trust (All Systems)
    • 4275 COVID-19 Certification

    6000 Series

    • 6100 Request for Retirement Benefit Estimate (All Systems)
    • 6101G General Assembly Retirement System Application for Service Retirement Benefits
    • 6101J Judges and Solicitors' Retirement System Application for Service Retirement Benefits
    • 6101N SCNG Service Retirement Application
    • 6101P Police Officers Retirement System Application for Service Retirement Benefits
    • 6101S South Carolina Retirement System Application for Service Retirement Benefits
    • 6151P Police Officers Retirement System Application for Disability Retirement
    • 6151S South Carolina Retirement System Application for Disability Retirement
    • 6251 Member's Disability Report
    • 6253 Employer's Disability Employment Status Report
    • 6254 Employer's Description of Disability Applicant's Job
    • 6255 Authorization for Release of Information
    • 6291 Administrative Appeal Disability Report
    • 6302 Retiring Member's Service Application Checklist
    • 6352 Retiring Member's Disability Applications Checklist
    • 6500 Employer Eligibility Determination Request
    • 6501 Employer Resolution and Application (SCRS)
    • 6501P Employer Resolution and Application (PORS)
    • 6502 Application to Append Coverage for Incidental Death Benefit (SCRS)
    • 6502P Application to Append Coverage for Incidental Death Benefit, Accidental Death Program and/or Firefighters Coverage (PORS)
    • 6503 Electronic Employer Services (EES) Employer Confidentiality Agreement
    • 6504 Electronic Employer Services (EES) Authorizing Contact Designation/Agreement
    • 6505 Electronic Employer Services (EES) Designated Agent Confidentiality Agreement

    7000 Series

    • 7201 Retired Member Change of Beneficiary (South Carolina Retirement System, Police Officers Retirement System)
    • 7201G Retired Member Change of Beneficiary Form (GARS)
    • 7202 Withholding Certificate for Monthly Benefit Payments
    • 7204 Direct Deposit Authorization
    • 7213 Authorized Representative Form
    • 7214 School Resource Officer Critical Needs Certification
    • 7216 COVID-19 Earnings Limitation Exception Certification
    • 7217 Termination of Retired Member Working Under Earnings Limit
    • 7500 Teacher and Employee Retention Incentive (TERI) Payout Election Form
    • 7700 Deduction Form, Public Safety Officer Insurance Payment Program - EIP Only
    • 7701 Deduction Form, Public Safety Officer Insurance Payment Program - Non-EIP
    • 7800 Deferred benefit Account (JSRS) Payout Form

    Death

    Employer

    Enrollment

    GARS

    Installment

    JSRS

    Leaving covered employment

    PORS

    Public safety

    Refund

    Retirement - disability

    Retirement - service

    SCRS

    Service purchase

    State ORP

    Trust certification