Employer Forms and Publications

Forms and Publications

Document Sort descending Description Topic
2024 Annual Comprehensive Financial Report (PDF)

Review financial, investment, and other information about PERA's pension administration.

Financial
2024 Popular Annual Financial Report (PDF)

Review a financial summary that highlights several sections of the ACFR.

Financial
2024 Summer Employer Newsletter (PDF)

This archived newsletter provides PERA news and updates from July 2024.

News
Ambulance Service Questionnaire

An ambulance service uses this form to request participation in PERA's DCP Ambulance Plan.

Eligibility
Annual Exclusion Report (PDF)

Only employers who lack technology to access ERIS may use this form.

Reporting
Correctional Plan Certification (PDF)

Use this form to certify an employee's eligibility for the Correctional Plan.

Eligibility
Election by Labor Organization Employee (PDF)

Members use this form to continue PERA as an employee of a labor organization.

Eligibility
Exemption from Web Reporting (PDF)

This form must be completed by employers who lack technology to use ERIS.

Reporting
Full-time Student Exclusion Certification (PDF)

Complete this form each semester for excluded full-time students under age 23.

Eligibility
Guide to Reporting Salary Overview (PDF)

Handout for the Guide to Reporting Salary program.

Refund
Guide to Reporting Salary Q&A (PDF)

Answers to your questions from the Guide to Reporting Salary program.

Refund
How to Report PERA Contributions on a W-2 (PDF)

Instructions to report PERA contributions on the IRS Form W-2.

Reporting
Increasing the SVF Plan Benefit Level (PDF)

What to review when considering an SVF benefit level increase.

SVF
Independent Contractor or Employee (PDF)

Eligibility requirements of employees and independent contractors.

Retirement
Individual Record of Earnings (PDF)

Use this form upon request or when an employee wasn't enrolled.

Eligibility
Leave Program Certification (PDF)

Use this form if you have a leave program as a budgetary savings measure.

Reporting
Leave Reporting Overview

Handout for the leave reporting program.

Reporting
Member Information Change Report (PDF)

Only employers who lack technology to access ERIS may use this form.

Reporting
Membership Election for Certain Ambulance Rescue.pdf

Complete within the first 30 days of work for optional PERA membership.

Eligibility
Membership Election for City Managers (PDF)

Complete within the first 30 days of work for optional PERA membership.

Eligibility
Membership Election for Governmental Physicians (PDF)

Complete within the first 30 days of work for optional PERA membership.

Eligibility
Membership Election for Public Officials (PDF)

Complete within the first 30 days of work for optional PERA membership.

Eligibility
Membership Eligibility Checklist (PDF)

Use this checklist to determine if an employee is eligible for a PERA Defined Benefit Plan.

Eligibility
Military Leave Verification (PDF)

Your employer completes this form for a military leave of absence.

Purchase
Notice of Exclusion from PERA Membership (PDF)

Use this optional form for an employee excluded from PERA upon hire.

Eligibility
Notice of Member Enrollment (PDF)

Only employers who lack technology to access ERIS may use this form.

Reporting
Phased Retirement Option (PDF)

This fact sheet provides an overview of the Phased Retirement Option (PRO).

Retirement
Phased Retirement Option Agreement (PDF)

Complete this form before phased retirement employment begins.

Retirement
Privatization (PDF)

This publication will help you understand how privatization impacts your benefit.

Retirement
Privatization Verification of Employment Status (PDF)

This form verifies a member's privatization employment status to start their PERA benefit.

Retirement
Questionnaire for Prospective PERA Employers (PDF)

Use this form to have your organization reviewed to join PERA.

Eligibility
Sample Resolution - Provide DCP Coverage Option to Eligible Firefighters (Word)

Use this sample resolution to extend DCP coverage to eligible firefighters. 

Eligibility
Sample Resolution – Blanket Part-Time Firefighter (Word)

Use this sample resolution to include part-time firefighters in Police & Fire Plan.

Eligibility
Sample Resolution – Blanket Part-Time Police Officer (Word)

Use this sample resolution to include part-time police officers in Police & Fire Plan.

Eligibility
Sample Resolution – Part-Time Firefighter (Word)

Use this sample resolution to include a part-time firefighter in Police & Fire Plan.

Eligibility
Sample Resolution – Police & Fire Member Transfer (Word)

Use this sample resolution to continue Police & Fire Plan for a member who transfers.

Eligibility
SVF Cost Analysis for Defined Benefit Plan (PDF)

This form is completed by the department who is considering the SVF defined benefit plan.

SVF
SVF Retirement Application (PDF)

This application is completed by SVF members for a lump-sum benefit.

SVF
SVF Sample Resolution to Increase Benefit Level (Word)

Use this sample resolution to increase the SVF benefit level.

SVF
SVF Sample Resolution to Join DB Plan - Governing Body (Word)

Use this sample resolution to join the SVF - DB Plan for governing bodies.

SVF
SVF Sample Resolution to Join DB Plan - Relief Association (Word)

Use this sample resolution to join the SVF - DB Plan for relief associations.

SVF
SVF Sample Resolution to Join DC Plan - Governing Body (Word)

Use this sample resolution to join the SVF - DC Plan for governing bodies.

SVF
SVF Sample Resolution to Join DC Plan - Relief Association (Word)

Use this sample resolution to join the SVF - DC Plan for relief associations.

SVF
Understanding PERA (PDF)

This publication provides the basics about PERA benefits.

Retirement
Verification of Termination (PDF)

This form is completed with the Retirement Application to verify termination requirements.

Retirement
Virtual Benefit Fair

This publication highlights key resources about PERA benefits.

Retirement