kpers@kpers.org      Toll-free: 1-888-275-5737 or Topeka: 785-296-6166

Forms

Listed by Number

  • KPERS-1, Report of Member Status, (PDF, 258KB)
  • KPERS-1R, Please report new retiree employment under "Enrollments" on the employer web portal.
  • KPERS-1C, School Employee - Certification of Concurrent Employment, (PDF, 191KB)
  • KPERS-2, Designation of Agent, (PDF, 299KB)
  • KPERS-2A, Additional Employer Web Portal Access, (PDF, 210KB)
  • KPERS-2B, Change of Employer Contact Information, (PDF, 154KB)
  • 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)
  • Substitute W-4P, Withholding Certificate for Pension Benefit Payments, (PDF, 218KB) - simplified version of IRS W-4P
  • IRS W-4P, Internal Revenue Service Withholding for Pension Payments form, (PDF, 277KB)
  • IRS W-4, (For Disability Recipients) Employee's Withholding Allowance Certificate (link to www.irs.gov)
  • KPERS-7/99, Designation of Beneficiary, (PDF, 257KB)
  • KPERS-7/99R, Designation of Beneficiary - Retired, (PDF, 235KB)
  • KPERS-7/99A, Designation of Beneficiary for Life Insurance - Board of Regents, (PDF, 203KB)
  • 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-10LR, Certification of Legislative Service (For Session Employees), (PDF, 24KB)
  • KPERS-12, Request for Member Information Change, (PDF, 182KB)
  • KPERS-13 Booklet, Application for Withdrawal of Contributions and Related Forms, (PDF, 340KB) Available in print
  • KPERS-13, Withdrawal of Contributions, (Form Only), (PDF, 130KB)
  • KPERS-14, Authorization to Release Information, (PDF, 141KB)
  • KPERS-15 Booklet, Application for Retirement Benefits and Related Forms, (PDF, 485KB) Available in print
  • KPERS-15, Application for Retirement Benefit, (Form Only) (PDF, 330KB)
  • KPERS-15B, Direct Deposit - Agreement for Payment of Benefit to Financial Institution, (PDF, 215KB)
  • KPERS-15E, Retirement Benefit Estimate Request, (PDF, 155KB)
  • KPERS-15S, KPERS Retiree Earnings Limitation Form, (PDF, 187KB)
  • KP&F-15S, KP&F Retiree Earnings Limitation Form, (PDF, 142KB)
  • 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)
  • Important Tax Information Booklet, (PDF, 195KB)
  • KPERS-40DOB, Date of Birth Affidavit, (PDF, 134KB)
  • KPERS-40NC, Name Change Affidavit, (PDF, 200KB)
  • KPERS-60, Employer's Report of Disability, (PDF, 196KB)
  • KPERS-61, Employer's Report of Death, (PDF, 199KB)
  • 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-101, Supplemental Form - Withdrawal of Contributions, (PDF, 132KB)
  • KPERS-EF105, Authorization for Electronic Funds Transfer, (PDF, 150KB)
  • KP&F-523, Application for Disability, (PDF, 54KB)
  • KP&F-538, Physician's Report of Member's Condition, (PDF, 48KB)
  • KP&F-560, Employer's Report of a Disability or On-The-Job Accident, (PDF, 150KB)
  • KP&F-561, Employer's Report of Death, revised 11/15 (PDF, 180KB)
  • KPERS-700I, Change of Address Form for Retired and Inactive Members, (PDF, 128KB)
  • The Standard Insurance Company - Optional Group Life Insurance Enrollment Form
  • The Standard Insurance Company - Insurance Conversion Information and Form
  • The Standard Insurance Company - Election of Portable Term Life Coverage
  • The Standard Insurance Company - Insurance Accelerated Death Benefit Claim Form
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Kansas Public Employees Retirement System
611 S. Kansas Ave, Topeka, KS 66603
Toll-free: 1 888 - 275-5737
Email: kpers@kpers.org