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Disability

Forms


 

General Employees Retirement Plan

  Application for Disability (pdf)

  Medical Statement (pdf)

  Employer Certification Form (pdf)

 

Correctional Retirement Plan

  Application for Disability (pdf)

  Medical Statement (pdf)

  Employer Certification Form (pdf)

 

State Patrol Retirement Plan

  Application for Disability (pdf)

  Medical Statement (pdf)

  Employer Certification Form (pdf)

 

Tax Withholding Certificates

  W-4P, Federal tax withholding (pdf)

  W-4MNP, Minnesota state tax withholding (pdf)


Note: MSRS cannot provide advice about how to complete these tax forms. If you have questions about your particular situation, please contact a tax or legal advisor.


Misc Forms

  Direct Deposit Agreement (pdf)