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

    • Print this page

    Forms

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

    Employer Forms

    EZLink
    Description Download
    ACH Debit Form
    Use this form to authorize MissionSquare Retirement to directly debit funds from an employer's bank account to fund contribution files that are submitted via EZLink.
    PDF document View
    EZLink Access Form
    Use this form to request a new EZLink user, and to update or remove an existing user.
    PDF document 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 MissionSquare Retirement and VRS Defined Contribution Plans.
    PDF document View
    EZLink Third-Party Access Form
    Use this form to authorize MissionSquare Retirement 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 document 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 document 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 Name Download Component  Type
    Beneficiary Designation (VRS-2)
    To designate more than 3 beneficiaries, a continuation form, the VRS-2A, is also required.
    PDF document View DB
    Designation of Beneficiary – Continuation (VRS-2A) PDF document 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 document View DC

     

    Refunds & Distributions
    Form Name Download Component Type 
    IRS 402(f) - Special Tax Notice
    Before taking a refund, read this notice, which explains the tax consequences of taking a refund versus direct rollover into another plan.
    PDF document View DB
    Name and Address Declaration for Deferred Members (VRS-3A) PDF document View DB
    Direct Rollover/Transfer Request
    Members must log in to their account and download the Direct Rollover/Transfer Request Form to request a rollover or transfer from the plan.
    Login DC
    Distribution Request
    Members must log in to their account and select Withdrawals to request a full, partial, installment, or required minimum distribution (RMD) from their account.
    Login DC

    In-Service Distribution Request
    Members must log in to their account and download the In-Service Distribution Request Form to request a withdrawal from money that was previously rolled into the plan from another retirement plan.

    Login DC
    Beneficiary Claim Request Form
    This form is used by beneficiaries to claim account assets when a participant has passed away.
    PDF document View DC
    IRS Form W-4P: Withholding Certificate for Pension or Annuity Payments
    Members use this form to change their tax withholding on their distribution.
    PDF document View DB, DC

     

    Rollovers
    Form Name Download Component Type 
    Incoming Rollover Form
    Use this form to request a direct rollover of your assets from your previous employer’s retirement plan (401(a), 401(k), Governmental 457(b), 403(b), Federal Thrift Savings) to your Hybrid 457 Deferred Compensation Plan.
    PDF document View DC
    Coronavirus-Related Distribution (CRD) Repayment Form
    Use this form to repay your CRD within three years of taking the distribution.
    PDF document View DC

     

    Account Authorization
    Form Name Download Component  Type
    Authorization to Discuss VRS Account Information (VRS-900) PDF document View DB
    Durable Power of Attorney (VRS-901) PDF document View DB
    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 document View DC

    Forms

    Other VRS Forms
    Form Name Download Component  Type
    Securian Financial/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)
    Before completing the form, log in to myVRS for retirement counseling resources and review the Apply for Retirement page to determine if you can retire online.
    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
    Approved Domestic Relations Orders - Defined Benefit Plan
    The Code of Virginia authorizes VRS to make a direct payment to a former spouse if the court awards your former spouse part of your benefit. In this situation, provide this form to your attorney to submit.
    PDF icon View DB
    Approved Domestic Relations Orders - Defined Contribution Account(s)
    The Code of Virginia authorizes VRS to make a direct payment to a former spouse if the court awards your former spouse part of your benefit. In this situation, provide this form to your attorney to submit.
    PDF icon View DC
    Authorization for Direct Deposit of Monthly Benefit (VRS-57)
    Retirees can update direct deposit information online through myVRS.
    PDF icon View DB
    Name and Address Declaration for Retirees (VRS-58) 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
    partial VRS