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  Last Updated: 12/02/2014
   Forms & Brochures
  All forms are in Adobe Acrobat format and are fully compatible with Adobe's accessibility tools. You can download Acrobat for free at http://www.adobe.com/products/acrobat/readstep.html or use the online conversion tool available at http://access.adobe.com/acrobatmain.html to view any of these files.
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  Retirement Applications
Beneficiary Designation
Disability Applications
Health Care Savings Plan
Employer Forms
Minnesota Deferred Compensation Plan (MNDCP)
Unclassified Plan
 Retirement Applications:
 How To Apply For Retirement Benefits Download
 How to Prepare for Retirement Download
 General Plan Download
 Correctional Plan Download
 Judges Plan Download
 State Patrol Plan Download
 Unclassified Plan Download
 Legislators Plan Download
 Direct Deposit Download
 Withholding Certificate Form W-4P Download
 Federal and State Income Tax Information Download
 Beneficiary Designation and Spousal Waiver:
 General, Correctional, Unclassified, Pilots, Military Affairs, and Fire Marshals Plans Download
 State Patrol, Judges, Legislators, and Elective Officers Plans Download
 Spousal Waiver (General, Correctional and Unclassified Plans) Download
 Health Care Savings Plan Download
 Minnesota Deferred Compensation Plan (MNDCP) Download
 Disability Applications:
 A Path to Understanding Disability Benefits Download
 Disability Process and Benefit General Plan Coming soon
 Disability Process and Benefit Correctional Plan Download
 Disability Process and Benefit State Patrol Plan Download
 Application General Plan Download
 Application Correctional Plan Download
 Application State Patrol Plan Download
 Physicians Statement General Plan Download
 Physicians Statement Correctional Plan Download
 Physicians Statement State Patrol Plan Download
 Certification form General Plan Download
 Certification form Correctional and State Patrol Plans Download
 Health Care Savings Plan:
 HCSP at a Glance Brochure Download
 Reimbursement Request Form Download
 Beneficiary Designation Download
 Direct Deposit Download
 Eligible Expenses Download
 Reimbursement Suspension Election 2015 Download
 Letter of Medical Necessity Download
Employer Forms:
 Employer Contact Information Form (HCSP/MNDCP) Download*
 HCSP Contract Approval/Renewal Download*
 ACH Debit Authorization Form Download
 Sample HCSP Contract Language Download
 Request For Taxpayer Identification Number Download
 Notification of Rehired Employee Download
* This form contains electronic input fields. Please fill in the fields then print the document. If completing the Employer Contract Information form, be sure to sign and date. Mail or fax the form to MSRS along with any required supporting documents. You can also choose to print the document and fill it out by hand.
 Unclassified Plan:
 Transfer Prior Service to Unclassified Plan Download
 Retirement Application Download
 Beneficiary Designation and Spousal Waiver Download
 Election To Be Covered By General Plan - 10 year service Download
 Election To Be Covered By General Plan - Hired after June 30, 2010 Download
 Minnesota Deferred Compensation Plan (MNDCP):
 Participant Enrollment Agreement Download
 Beneficiary Designation Download
 Personal Information Change Download
 Incoming Direct Rollover Download
 Direct Deposit Agreement Download
 TD Ameritrade Enrollment Download
 MSRS Divorce Information Download
 MSRS Domestic Relations Order Sample Language Download
 MSRS Unclassified Plan Domestic Relations Order Sample Language Download
 HCSP - Composing a Court Order Download
 HCSP - Domestic Relations Order Sample Language Download
 MNDCP - Composing a Court Order Download
 MNDCP - Domestic Relations Order Sample Language Download
 Revocation of Survivor Download
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Minnesota State Retirement System
60 Empire Drive, Suite 300, St. Paul, MN 55103-3000
Telephone: (651) 296-2761, Toll Free: (800) 657-5757, Fax: (651) 297-5238
E-Mail: info@msrs.us
Please do not include confidential information, such as social security numbers, in email
correspondence with MSRS.
An Equal Opportunity Employer
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