Resource Center for VRS Employers: Hybrid Retirement Plan

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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 View
EZLink Access Form
Use this form to request a new EZLink user, and to update or remove an existing user.
PDF 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 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 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 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)
Members can update beneficiaries online through their secure myVRS account.
N/A DB
Beneficiary Designation
Members must log in to choose or change the designated beneficiary for their account. This will ensure an immediate update to their beneficiary information.
Login 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.
PDF 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
Workforce Transition Act (WTA) Distribution/Rollover Request Form
Members must log in to their account and download the Workforce Transition Act (WTA) Distribution/Rollover Request Form if they have separated employment and are receiving benefits under WTA.
Login DC
Beneficiary Claim Request Form
This form is used by beneficiaries to claim account assets when a participant has passed away.
PDF 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 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 View DC
Coronavirus-Related Distribution (CRD) Repayment Form
Use this form to repay your CRD within three years of taking the distribution.
PDF 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 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.
Website icon View DB
State Health Benefits Program Enrollment Form For Retirees, Survivors And LTD Participants (A10741) PDF icon View DB
College and University Opt-Out Form (VSDP-2) PDF icon View DB
Name and Address Declaration for Deferred Members (VRS-3A) 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