Basic Forms (PDFs)

Form	Description
Certification of Compensation and Service Hours	Certification of employee compensation and hours.
Certification of Service to be Purchased for Out of State Public Service	Certification of Service to be Purchased for Out of State Public Service.
Election and Certification to Purchase Absence	This form is for the certification and purchasing of service credit for absent time covered under the Uniformed Services Employment and Re-employment Act (USERRA), and Workers' Compensation.
Health Insurance Authorization	A retiring member may authorize MPERA to deduct health insurance premiums from their retirement benefit.
Name Change	If your employee changes their name, please have them complete this form, return it to you, the employer, so that you may update your datafile with the new information, and then you, the employer, return it to MPERA.
Portal Access Manager Security Agreement	Must be completed by new primary users to access the MPERA Online Payroll Reporting System.
Retirement Fund Information	If an employee terminates, please give them this information regarding their retirement funds
VFCA Roster	Printable roster for VFCA Fire Chiefs.

PERS Optional Membership Form (DocuSign)

DocuSign is a secure online location where you sign in and fill out an MPERA form. Upon completion, the form will automatically be sent to MPERA for processing.

Form	Description
Public Employees' Retirement System (PERS)	New employees hired into certain optional positions may elect to join PERS.

Optional Membership Forms (PDFs)

Form	Description
Public Employees' Retirement System (PERS)	New employees hired into certain optional positions may elect to join PERS.
SD Flowchart	Optional Membership flowchart for School District employees.
Non-SD Flowchart	Optional Membership flowchart for non-School District employees.
Part-Paid FireFighter Optional Membership form	Part-paid firefighters who meet the eligibility requirements may elect to join FURS.

Local Elected Official Optional Membership Forms (PDFs)

Form	Description
Current PERS Member	A person who is an active member of PERS may elect to participate in PERS as a local elected official. This applies only to positions with less than 960 hours in a fiscal year.
Retired PERS Member	A person who is a retired member of PERS may elect to participate as an active member of PERS as a local elected official.
Non-PERS Member	A person who is not a member of PERS may elect to participate in PERS as a local elected official.

Membership/Beneficiary Designation Forms (PDFs)

Form	Description
PERS Membership/Designation of Beneficiary Form	The Public Employee Retirement System membership form is for new hires and for current PERS members who wish to change their designated beneficiaries.
JRS Membership /Designation of Beneficiary Form	The Judges' Retirement System membership Form is for new hires and for current JRS members who wish to update their statutory beneficiaries or change their designated beneficiaries.
HPORS Membership /Designation of Beneficiary Form	The Highway Patrol Officers' Retirement System membership form 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 Form	The Sheriffs' Retirement System membership form is for new hires and for current SRS members who wish to change their designated beneficiaries.
GWPORS Membership /Designation of Beneficiary Form	The Game Wardens' and Peace Officers' Retirement System membership form is for new hires and for current GWPORS members who wish to change their designated beneficiaries.
MPORS Membership /Designation of Beneficiary Form	The Municipal Police Officers' Retirement System membership Form 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 Form	The Firefighters' Unified Retirement System membership Form 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 Form	The Volunteer Firefighters' Compensation Act Designation of Beneficiary Form is for volunteer firefighters to name their statutory beneficiaries.