Forms & Publications
Actuarial Military Purchase
This fact sheet provides an overview of the actuarial military service credit purchase option available to active members.
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Ambulance Service Questionnaire
This form is used by entities to establish the eligibility of an ambulance service for inclusion in the PERA program.
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Annual Exclusion Report
This form is only for use by employers who lack internet and email capabilities to access PERA’s Employer Reporting & Information System (ERIS). Complete this form to report employees who are excluded from PERA coverage.
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Annual Increase - Coordinated
This fact sheet explains the annual increase for Coordinated members.
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Annual Increase - Correctional
This fact sheet explains the annual increase for Correctional members.
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Annual Increase - Police & Fire
This fact sheet explains the annual increase for Police & Fire members.
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Application - Refund
Complete this refund application if you would like a one-time payment of your contributions plus interest from the Coordinated, Police & Fire, Correctional, or Defined Contribution membership plans.
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Application - Retirement
Complete this retirement application to apply for monthly retirement benefits from the Coordinated, Police & Fire, or Correctional membership plans. A separate application is required for each plan.
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Applying for a Refund | Refund and Taxes
This fact sheet provides an overview of your refund options to receive a one-time payment of your contributions plus interest. If you are vested in your plan, you may qualify for a lifetime monthly benefit instead of a refund.
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Applying for Benefits - Coordinated
This publication provides an overview of monthly retirement benefits for Coordinated members.
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Applying for Benefits - Correctional
This publication provides an overview of monthly retirement benefits for Correctional members.
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Applying for Benefits - Police & Fire
This publication provides an overview of monthly retirement benefits for Police & Fire members.
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Benefit Options Worksheet
Which PERA pension is right for you? This worksheet may make the decision a little easier.
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Combined Service Annuity
This publication provides an overview of contributing to multiple MN public pension plans and its impact to your benefits.
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Correctional Officer Certification
This form is used to certify the eligibility of an employee for PERA’s Local Correctional Employees Retirement Plan.
May only be used by employers who lack the ability to access PERA’s Employer Reporting and Information System (ERIS)
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Countdown to Retirement
This publication outlines steps to take throughout your career as you plan your countdown to retirement.
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DCP Investment Selection
Use this form to make investment selections in the Defined Contribution Plan, or to transfer funds from previous investment choices to new ones.
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DCP Membership Certification for Certain Ambulance, Rescue or Volunteer Firefighter Positions
Employers complete this form for individuals who meet the eligibility requirements of PERA’s Defined Contribution Plan (DCP) and requested DCP participation.
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Direct Deposit
Use this form for electronic deposit of your monthly benefit to your checking or savings account.
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Divorce Guide
This guide assists involved parties with the impact of divorce to PERA benefits, as it is considered marital property.
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Election for Exclusion from the Coordinated Plan by a City Manager
City managers and employers use this form to revoke membership in the Coordinated Plan and make a different selection.
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Election for Inclusion in the Coordinated Plan By a City Manager/Administrator
City managers/administrators use this form to elect Coordinated Plan participation.
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Eligibility Checklist
Use this checklist to determine if an employee is eligible for a PERA Defined Benefit Plan.
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Exemption from Web Reporting
Employers who lack required computer technologies must complete this form to document that they are exempt from web reporting.
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Full-time Student Exclusion
Use this form to confirm exclusion from membership in PERA of any employee who is a full-time student and under the age of 23.
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Guide for Member of the Public Requesting Information
This publication provides an overview of requesting public data from PERA.
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Guidelines for Composing Court Orders
This publication provides an overview of composing court order language for PERA benefits due to marital dissolution.
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Handbook - Defined Contribution Plan
This handbook contains plan information for defined contribution plan (DCP) members.
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How to Report PERA Contributions on a W-2
This publication provides a summary on how to report PERA pension contributions on IRS form W-2.
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Independent Contractor or Employee
Complete this form to determine if you are an independent contractor or working in a PERA-covered position.
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Individual Record of Earnings
Employers are to complete this form when responding to a request from PERA for the employment status and earnings of an individual whereby contributions were not reported to PERA from the beginning of employment with your agency; or reporting the earnings of a PERA-eligible employee who was either overlooked or mistakenly excluded and for whom deductions were not withheld.
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Labor Organization Employee Election
If you are a public employee who has been contributing to PERA’s Coordinated Plan and you are taking an authorized leave of absence from your employer to work for a labor organization that represents public employees, you may choose to continue to contribute to PERA from your earnings as a labor organization employee. Complete this form to continue contributions to PERA during your leave.
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Leave Program Certification Form
Complete this spreadsheet to detail the effects of a leave/furlough program on PERA-covered employees’ salaries.
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Leave Verification - Military
Use this form for a military leave that occurred during public employment and you are within the original purchase time-frame. The military purchase must be made within three times the length of the leave (minimum of one year, maximum five years) or within 30 days after the termination of public service, whichever is earlier.
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Member Information Change Report
Use this form to report changes that have occurred in the name or employment status of your PERA members.
Form may only be used by employers who lack the ability to access PERA’s Employer Reporting and Information System (ERIS)
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Membership Election by a Governmental Physician
Physicians working at a governmental institution must participate in the Coordinated plan, unless the physician opts, within 90 days, to participate in the Defined Contribution Plan. Use this form to make the selection.
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Membership Election by Public Officials
Use this form for elected public officials to determine which, if any, PERA plan to participate in.
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Notice of Member Enrollment
Complete this form to enroll an employee whose coverage under the Coordinated, Correctional, Police and Fire or Basic plan is required.
This form may only be used by employers who lack the ability to access PERA’s Employer Reporting and Information System (ERIS)
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Notice to Discontinue Defined Contribution Plan Participation
Minnesota law allows elected officials and city managers who are participating in the PERA Defined Contribution Plan (DCP) to discontinue membership at any point during their incumbency/employment. Upon doing so, however, the individuals may not receive a distribution of their DCP account balances until they terminate all public service. Use this form to elect to opt out of existing PERA coverage.
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Payment Recipient Address Change
If you are currently receiving a PERA benefit and need to change your address.
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Phased Retirement Fact Sheet
This fact sheet provides an overview of the Phased Retirement Option (PRO).
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Privatization Fact Sheet
This publication will help you understand how privatization affects your PERA benefit.
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Prospective Employer Questionnaire
Employers complete this form to determine eligibility of your organization to participate in PERA.
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Release of Information
Use this form to release your personal information to another individual, agency, or firm. PERA will not release information without your consent.
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Repaying a Refund
This publication explains eligibility to repay past PERA refunds to restore lost service credit.
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Request for SVF Plan Benefit Level Change
This form is completed by a municipality or firefighting corporation in order to request a cost analysis of increasing the benefit level of a fire department that has already joined the plan.
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Request for SVF Plan Cost Analysis to Join
This form is completed by a fire department that is considering joining the SVF to get an estimate of future annual contributions required to provide the level of benefits selected.
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Resources and Contacts
A list of retirement information and resources outside of PERA for Minnesotans.
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Retirement Checklist
This checklist summarizes the necessary documents to apply for your retirement benefit along with other important information to know as you prepare for retirement.
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Sample Resolution - Dual Firefighter Position
This sample resolution is used by employers for firefighters in dual positions.
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Sample Resolution - Dual Police Officer Position
This sample resolution is used by employers for police officers in dual positions.
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Sample Resolution - Join SVF Plan
This sample resolution is used by entities opting to join the voluntary statewide lump-sum volunteer firefighter retirement plan.
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Survivor Options
This fact sheet explains survivor options available when electing someone other than your spouse.
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SVF Plan Retirement Benefit Application
SVF Plan Only – this form is used by a SVF Plan firefighter who has severed his or her employment relationship with the fire department and wishes to receive a lump-sum benefit from the plan.
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SVF Plan Sample Resolution to Increase Benefit Level
SVF Plan Only – this document provides the proper format of a resolution and the required information for an entity opting to increase the benefit level for firefighters who are vested in the statewide plan.
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SVF Plan Survivor Benefit Application
SVF Plan Only – this application form is completed by the survivor of a SVF Plan firefighter who dies prior to receiving his or her retirement benefit.
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Verification of Employment Status-Privatization
Privatization Only – complete this form to verify the employment status of a PERA member eligible for privatized benefits. Your privatized employer must complete a portion of this form.
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Verification of Termination
You must submit this form with your Retirement Application confirming you met termination requirements with this employer. Your employer must complete a portion of this form.
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W-4MNP
Complete the W-4MNP Minnesota state tax form for a refund or monthly benefits (retirement, survivor, or disability) and you want to withhold an amount different than the default. If you have multiple PERA monthly benefits, and would like different tax selections for each benefit, then you will need to fill out a W-4MNP for each plan.
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W-4P
Complete the W-4P federal tax form for monthly benefits (retirement, survivor, or disability) if you want to withhold an amount different than the default of Single, 0 exemptions. If you have multiple PERA monthly benefits, and would like different tax selections for each benefit, then you will need to fill out a W-4P for each plan.
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Working After Retirement
This publication provides information on how earnings limits impact your benefit if you return to PERA-covered employment.