Montana Public Employee Retirement Administration

Basic Forms (PDFs)

Form Description
Certify Service/Salary Certification of employee compensation and hours.
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 and 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.

 

Optional Membership Forms (PDFs)

Form Description
Public Employees' Retirement System (PERS) New employees in certain 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.