ACH Authorization Form

Authorization for direct payments to MPERA.

Certify Service/Salary

Certification of employee compensation and hours.

Certification of USERRA Service

This form is for the certification and purchasing of service credit for absent time covered under the Uniformed Services Employment and Re-employment Act.

Certification of Workers' Compensation

This form is for the certification and purchasing of service credit for absent time covered under Workers' Compensation.

Change of Address for Retirees

Only retirees should use this form to notify MPERA of any address changes.

Health Insurance Authorization

A retiring member may authorize MPERA to deduct health insurance premiums from their retirement benefit.

Health Insurance Deduction Memo

A letter to employers regarding the deduction of health insurance premiums.

Name Change

If a member has changed their name, please have them complete this form and return it to MPERA.

Retirement Application for VFCA

Fill out to apply for a service retirement benefit based on time served and recorded by MPERA. This is for members of the Volunteer Firefighters' Compensation Act only.

Retirement Fund Information for Terminating Employees

If an employee terminates, please give them this information regarding their retirement funds.

Web Reporting Security Agreement

Must be completed by new primary users to access the MPERA Online Payroll Reporting System.

Web Reporting Security Agreement Add'l User

Must be completed by new secondary users to access the MPERA Online Payroll Reporting System.

Working Retiree Certification

Certification by pay period of working retirees under the Public Employee Retirement System (PERS), the Sheriffs' Retirement System (SRS) and the Firefighters' Unified Retirement System (FURS).

Optional Membership Forms

This form is for certain types of employment that allow the employee to choose to elect or decline membership in PERS. Refer to the Non-Contributing Employee Value Chart to see the list of positions that are OPTIONAL.

PERS Membership
/Designation of Beneficiary Cards

The Public Employee Retirement System membership card is for new hires and for current PERS members who wish to change their designated beneficiaries.

JRS Membership
/Designation of Beneficiary Cards

The Judges' Retirement System membership card is for new hires and for current JRS members who wish to change their designated beneficiaries.

HPORS Membership
/Designation of Beneficiary Cards

The Highway Patrol Officers' Retirement System membership card is for new hires and for current HPORS members who wish to update their statutory beneficiaries or change their designated beneficiaries.

SRS Membership
/Designation of Beneficiary Cards

The Sheriffs' Retirement System membership card is for new hires and for current SRS members who wish to change their designated beneficiaries.

GWPORS Membership
/Designation of Beneficiary Cards

The Game Wardens' and Peace Officers' Retirement System membership card is for new hires and for current GWPORS members who wish to change their designated beneficiaries.

MPORS Membership
/Designation of Beneficiary Cards

The Municipal Police Officers' Retirement System membership card is for new hires and for current MPORS members who wish to update their statutory beneficiaries or change their designated beneficiaries.

FURS Membership
/Designation of Beneficiary Cards

The Firefighters' Unified Retirement System membership card is for new hires and for current FURS members who wish to update their statutory beneficiaries or change their designated beneficiaries.

VFCA Designation of Beneficiary Cards

The Volunteer Firefighters' Compensation Act Designation of Beneficiary card is for volunteer firefighters to name their statutory beneficiaries.