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Forms by Number

Forms listed by their number.

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Forms Listed in Ascending Order

  • Important Tax Information Booklet, (PDF, 195KB)
  • KPERS-1 - Enroll new members or report employment changes on Employer Web Portal.
  • KPERS-1C, School Employee - Certification of Concurrent Employment, (PDF, 191KB)
  • KPERS-2, Designation of Agent, (PDF, 299KB)
  • KPERS-2A, Change employer web portal access on EWP.
  • KPERS-2B, Change employer contact information on EWP.
  • KPERS-3, Elected Official Irrevocable Election of Membership (non-legislative), (PDF, 186KB)
  • KPERS-3A, KPERS Membership and Death and Disability Coverage (for Legislators), (PDF, 148KB)
  • KPERS-3BOR, Retirement Plan Election for Kansas Board of Regents Employees, (PDF, 150KB)
  • KPERS-3R, Election of Deferred Compensation Plan for KPERS Retirees (Legislators), (PDF, 131KB)
  • KPERS-3S, State Officer Retirement Plan Election, (PDF, 101KB)
  • KPERS-4, Election to Remain in the Board of Regents Retirement Plan During a Leave of Absence while Serving in the Kansas Legislature, (PDF, 132KB)
  • IRS W-4P, Withholding Certificate for Periodic Pension or Annuity Payments
  • IRS W-4, (For Disability Recipients) Employee's Withholding Allowance Certificate (link to www.irs.gov)
  • IRS W-4R (Withholding Certificate for Nonperiodic Payments and Eligible Rollover Distributions) (link to www.irs.gov)
  • KPERS-7/99, Designation of Beneficiary, (PDF, 257KB)
  • KPERS-7/99 Spanish, Nombramiento De Beneficiarios, (PDF, 243KB)
  • KPERS-7/99R, Designation of Beneficiary - Retired, (PDF, 235KB)
  • Additional Retirement Beneficiaries, (PDF, 178KB)- use this additional page if you have more retirement beneficiaries than space allows on the KPERS-7/99.
  • Additional Life Insurance Beneficiaries, (PDF, 180KB) - use this additional page if you have more life insurance beneficiaries than space allows on the KPERS-7/99.
  • KPERS-10, Employer Certification of Service, (PDF, 186KB)
  • KPERS-11, Member Payroll Department Change, (PDF, 206KB)
  • KPERS-12, Request for Member Information Change, (PDF, 182KB)
  • KPERS-13 Booklet, Application for Withdrawal of Contributions and Related Forms, (PDF, 340KB) – Request a paper copy.
    For KPERS 457 transactions, please do not use this form. Please call 1-800-232-0024 for assistance.
  • KPERS-14, Authorization to Release Information, (PDF, 141KB)
  • KPERS-15 Booklet, Application for Retirement Benefits and Related Forms, (PDF, 485KB) – Request a paper copy
  • K-15/3, Application for Retirement Benefit for KPERS 3 members, (PDF, 421KB)
  • KPERS-15B, Direct Deposit - Agreement for Payment of Benefit to Financial Institution, (PDF, 215KB)
  • KPERS-15E, Retirement Benefit Estimate Request, (PDF, 155KB)
  • KPERS-15RE Employer Certification of No Prearranged Employment (PDF, 126KB)
  • KPERS-17 EPD, Arrearage Adjustment to Prior Contribution Report -- Employer Paid, (PDF, 216KB)
  • KPERS-17 OPT, Arrearage/Refund Adjustment to Prior Contribution Report, (PDF, 216KB)
  • KPERS-17 Table, Arrearage Adjustment Factor Table, (PDF, 76KB)
  • KPERS-40DOB, Date of Birth Affidavit, (PDF, 134KB)
  • KPERS-40NC, Name Change Affidavit, (PDF, 200KB)
  • KPERS-67, Application to Purchase Service Credit, (PDF, 259KB)
  • KPERS-67J, Application to Purchase Service Credit – Judges, (PDF, 398KB)
  • KPERS-67PS, Application to Purchase Service Credit – Non-KPERS, (PDF, 409KB)
  • KPERS-67R, Service Credit Purchase via Rollover, PDF, 180KB)
  • KPERS-67T, Service Credit Purchase With a Trustee-to-Trustee Transfer and Fact Sheet, (PDF, 61KB)
  • KPERS-78, Affiliation for Optional Group Life Insurance,(PDF, 130KB)
  • KPERS-79, Optional Group Life Insurance Reduction or Cancellation, (PDF, 137KB)
  • KPERS-79C, Optional Group Life Insurance Continuation, (PDF, 232KB)
  • KPERS-79R, Optional Group Life Insurance Return to Payroll, (PDF, 130KB)
  • KPERS-700I, Change of Address Form for Retired and Inactive Members, (PDF, 128KB)
  • KP&F-15S, KP&F Retiree Earnings Limitation Form, (PDF, 142KB)
  • KP&F-503, Sheriff's Election of Membership, (PDF, 118KB)
  • KP&F-15DROP, Application for KP&F Deferred Retirement Option Program (DROP), (PDF, 150KB)
  • KP&F-15DROPEXT, Application to Extend KP&F Deferred Retirement Option Program (DROP) , (PDF, 230KB)
  • KP&F-15DROPDM, Application for KP&F DROP & Monthly Retirement Benefits, (PDF, 150KB)
  • KP&F-7/99DROP, Designation of Beneficiary - DROP, (PDF, 150KB)

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