CalPERS Members

Address Change

• Member Change of Address Form (PRS 221) (PDF, 102 KB)

Applying for Service Retirement

• Service Retirement Election Application Form¹ (BSD-369-S) (PDF, 77 KB)
• Service Retirement Election Application Form¹ (Nonmembers Only) (BSD-369-NM) (PDF, 71 KB)
• Retirement Allowance Estimate Request Form (BSD-470) (PDF, 53 KB)
• Retirement Allowance Estimate Request Form (Nonmembers Only) (BSD-470-NM) (PDF, 50 KB)
• Justification for Absence of Spouse's or Domestic Partner's Signature Form (BSD-800A) (PDF, 68 KB)
• Direct Deposit Authorization Form (BSD-1199P) (PDF, 81 KB)

¹Refer to the Service Retirement Guide (PDF, 243 KB) or Non-Member Service Retirement Guide (PDF, 189 KB) for important details on completing your application.

Applying for Disability Retirement

• Disability Retirement Election Application Form² (BSD-369-D) (PDF, 89 KB)
• Employer Information for Disability Retirement Form (PERS01M0052DMC) (PDF, 69 KB)
• Authorization to Disclose Protected Health Information Form (BSD-35) (PDF, 37 KB)
• Physical Requirements of Position/Occupational Title Form (PERS01M0050DMC) (PDF, 57 KB)
• Physician's Report on Disability Form (PERS01M0051DMC) (PDF, 52 KB)
• Report of Separation & Advance Payroll Information Form (BSD-194) (PDF, 39 KB)
• Justification for Absence of Spouse's or Domestic Partner's Signature Form (BSD-800A) (PDF, 68 KB)
• Workers' Compensation Carrier Request Form (BSD-92) (PDF, 52 KB)

²Refer to the Disability Retirement Guide (PDF, 363 KB) for important details on completing your application.

Beneficiary Designation

• Beneficiary Designation Form (Active only) (BSD-241) (PDF, 202 KB)
• Changing Your Beneficiary or Monthly Benefit after Retirement (PUB-98) (PDF, 302 KB)
• Beneficiary Designation for Survivor's Prorated Allowance (Survivors Only) (BSD-509B) (PDF, 72 KB)
• Nomination of Custodian for Minor Form (PDF, 39 KB)

Direct Deposit

• Direct Deposit Authorization Form (BSD-1199P) (PDF, 81 KB)
• Certification of Trust-Payment of Continuing Monthly Allowance (BSD-1962) (PDF, 33 KB)
• Payment of Monthly Allowance to a Trust Form (BSD-1961) (PDF, 28 KB)

Estimate Request

• Retirement Allowance Estimate Request Form (MSD-470) (PDF, 53 KB)
• Retirement Allowance Estimate Request Form (Nonmembers Only) (PDF, 50 KB) 

Power of Attorney

• Power of Attorney Form (PERS-OSS-138) (PDF, 61 KB)
• Certification of Trust-Payment of Continuing Monthly Allowance (BSD-1962) (PDF, 33 KB)

Refunding CalPERS Contributions

• Refund/Rollover Election Package (PDF, 151 KB)

Service Credit Purchase

• Alternate Retirement Program Form (PERS01M0351) (PDF, 93 KB)
• CA National Guard Military Form (PERS01M0393) (PDF, 77 KB)
• Comprehensive Employment and Training Act or Fellowship Form (MSD-370) (PDF, 93 KB)
• Layoff, Prior Service, and Optional Member Service Form (MSD-372) (PDF, 83 KB)
• Leave of Absence Form (MSD-371) (PDF, 90 KB)
• Military Service Credit³
• Military Leave of Absence Form (MSD-369) (PDF, 100 KB)
• Peace Corps or AmeriCorps*VISTA or Americorps Form (MSD-373) (PDF, 112 KB)
• Redeposit of Withdrawn Contributions³
• Service Prior to Membership³

³This form is only available when you complete an estimate using the Service Credit Cost Estimator.

Tax Withholding Change

• Tax Withholding Form (Retirees and Beneficiaries only) (PDF, 49 KB)

Working and Benefits after Retirement

• Internal Revenue Code Section 415(b) Fact Sheet (PDF, 166 KB)
• Request to Work While Receiving Disability/Industrial Disability Retirement Benefits Form (PDF, 33 KB)
• Retirement Allowance Estimate Request Form (MSD-470) (PDF, 53 KB)
• Changing Your Beneficiary or Monthly Benefit after Retirement (PUB-98) (PDF, 340 KB)
• Certification of Medicare Status (PERS08M0021DMC) (PDF, 20 KB)

Health Program

Judges' Retirement System

Judge Elected or Appointed Prior to November 9, 1994

• Judges' Service Retirement Application (PDF, 94 KB)
• Distribution of Judges' Retirement System ESIP (PDF, 70 KB)
• Judges' Retirement System Survivor and Beneficiary Information Form (PDF, 22 KB)

Judge Elected or Appointed After November 9, 1994

• Judges' Retirement System II Application (PDF, 38 KB)
• Distribution of JRS II Contributions or Monetary Credits (PDF, 119 KB)
• Judges' Retirement System II Survivor and Beneficiary Information Form (PDF, 21 KB)

Dated: 05-14-2013