Resource Center for VRS Employers: Hybrid Retirement Plan: Defined Contribution Component

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    Forms

    EZLink |  Beneficiary Designation | Refunds & Distributions | Rollovers | Account Authorization | Other VRS Forms 

    Employer Forms

    EZLink
    DescriptionDownload
    ACH Debit Form
    Use this form to authorize ICMA-RC to directly debit funds from an employer's bank account to fund contribution files that are submitted via EZLink.
    PDF icon View
    EZLink Access Form
    Use this form to request a new EZLink user, and to update or remove an existing user.
    PDF icon View
    EZLink Access Form — Dual Access
    Use this form to request a new EZLink user, and to update or remove an existing user for both the ICMA-RC and VRS Defined Contribution Plans.
    PDF icon View
    EZLink Third-Party Access Form
    Use this form to authorize ICMA-RC to issue an EZLink User ID and password for limited use by the employer's third-party benefits administrator(s), agents or contractors or any other non-employee.
    PDF icon View
    Request for Adjustment Review Form
    Use this form to request a review of contributions made to the Defined Component of the Hybrid Retirement Plan.
     PDF icon View


    Member Forms

    Important: Most forms do not apply to both components of the Hybrid Retirement Plan. Use the third column to determine if the form is needed for the Defined Benefit (DB) or Defined Contribution (DC) component.

    Beneficiary Designation
    Note: Beneficiaries must be designated separately for both components.
    Form NameDownloadComponent  Type
    Beneficiary Designation (VRS-2)
    To designate more than 3 beneficiaries, a continuation form, the VRS-2A, is also required.
    PDF icon View DB
    Designation of Beneficiary – Continuation (VRS-2A) PDF icon View DB
    Beneficiary Designation
    Members can also log in to their account and complete this online to ensure an immediate update to their beneficiary information.
    PDF icon View DC

     

    Refunds & Distributions
    Form NameDownloadComponent Type 
    Name and Address Declaration for Deferred Members (VRS-3A) PDF icon View DB
    VRS Hybrid 457 Deferred Compensation Plan Distribution/Direct Rollover/Transfer Request PDF icon View DC
    VRS Hybrid 401(a) Cash Match Plan Distribution/Direct Rollover/Transfer Request PDF icon View DC
    Beneficiary Claim Request PDF icon View DC
    IRS Form W-4P: Withholding Certificate for Pension or Annuity Payments PDF icon View DC

     

    Rollovers
    Form NameDownloadComponent Type 
    Hybrid 457 Incoming Transfer/Rollover Form PDF icon View DC

     

    Account Authorization
    Form NameDownloadComponent  Type
    Authorization to Discuss VRS Account Information (VRS-900) PDF icon View DB
    Durable Power of Attorney (VRS-901) PDF icon View DB
    Account Access Code
    This form is used in special situations in which an additional security level is needed when contacting Investor Services. Review the instructions for more details.
    PDF icon View DC
    Information Release Authorization
    Members use this form to authorize a third party to obtain information regarding their account. Please note that it does not authorize this individual to conduct transactions on the member's behalf.
    PDF icon View DC

     

    Forms

    Other VRS Forms
    Form Name Download Component  Type
    Minnesota Life/VRS Life Insurance Forms:
    VRS-31, VRS-32, VRS-35, VRS-37, VRS-38, VRS-39, VRS-39A, VRS-39R and VRS Certificate of Life Insurance.
    PDF icon View DB
    State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants (T-20879) PDF icon View DB
    College and University Opt-Out Form (VSDP-2) PDF icon View DB
    Application for Retirement (VRS-5) PDF icon View DB
    Request for Income Tax Withholding (VRS-15) PDF icon View DB
    Application for Purchase of Prior Service Credit (VRS-26) PDF icon View DB
    Authorization for After-Tax Payroll Deduction to Purchase Service Credit (VRS-26C)
    VRS members now select payment agreement type in myVRS and provide confirmation details page to employer.
    N/A DB
    Agreement for Pre-Tax Salary Reduction to Purchase Service Credit (VRS-26E)
    VRS members now select payment agreement type in myVRS and provide confirmation details page to employer.
    N/A DB
    Application for Contribution Make-Up for Hybrid Plan Participants Returning from Military Leave (VRS-26M) PDF icon View DC
    Request for Health Insurance Credit (VRS-45) PDF icon View DB
    Authorization for Direct Deposit of Monthly Benefit (VRS-57) PDF icon View DB
    Request for Estimate of Retirement Benefits (VRS-60) PDF icon View DB
    Request for Review of Membership Records (VRS-70) PDF icon View DB
    Authorization of Coverage Retention for the Long Term Care Plan (VSDP or VLDP) (VRS-170) PDF icon View DB
    Protection Against Unintentional Lapse of Long Term Care (VSDP or VLDP) (VRS-171) PDF icon View DB
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