Only for use by Employers that submit paper transmittals.
Return this form to your employer's Payroll Clerk. They must update their records as well. Otherwise, when they report to us each month, their "old" data will override our system.
Return this form to PERSI.
You may make voluntary contributions to the Choice 401(k) Plan. To begin contributions, return this form to your Payroll Clerk.
This worksheet is provided to assist you with the investment allocation of your Choice 401(k) Plan account. Print it out, fill it in and use it when you make changes to your account then keep it as a record of your selections.
The Choice Plan accepts rollover contributions from other qualified retirement plans. Instructions and additional information are included with the form to guide you through the process.
If you are no longer employed by a PERSI employer, you may receive your funds from the Choice Plan. Refer to the instructions on the form for complete information about a distribution or rollover from your Choice Plan account. The Special Tax Notice included with the form explains the tax consequences of taking a distribution from your retirement plan.
Use this form to certify that you are a beneficiary of a deceased Choice Plan participant and to request payment of the deceased participant's Choice Plan funds. Instructions and important tax information are included with the form.
Active members may take a full or partial distribution of their Choice 401(k) Plan "Rollover" sub-account either as a direct payment to them, as a rollover to an IRA or other eligible retirement plan or a combination of the two.
Active members who are at least 59½ years of age may take full or partial distribution of their "Prior Employee Pre-tax Contribution" sub-account either as a direct payment to them, as a rollover to an IRA or other eligible retirement plan or a combination of the two.
Use this form to request a hardship withdrawal from your eligible Choice 401(k) Plan funds to relieve an immediate and heavy financial need for one or more of the qualifying reasons defined in Section 6.2(c) of the Choice 401(k) Plan articles.
This is a collection of fill-in forms for members who are applying for retirement. When you fill in the name and address information on the first form (RS121 Retirement Application) the information is copied to the other forms, eliminating the need for repetitive entry.
Note! You must contact PERSI for a retirement estimate before completing and submitting these forms.

Helping Idaho Public Employees Build A Secure Retirement

PERSI Member Forms

Completing Forms: Some of the forms listed below also have instructions. We strongly suggest you read the instructions before completing the form. This will help ensure that the form is filled out correctly and will speed our fulfillment of your request. Incorrect or incomplete forms often must be returned, causing unnecessary delays for your request. Mouseover the Information Icon icon to view specific instructions for the form. If the Download Icon icon is available, you can submit the form online.

For all forms, double-check dates, numbers and signatures. This may seem elementary, but you would be surprised how often mistakes are made on the simplest of items. Please double-check the following:

  • Social Security Number - it is very important that we have your correct Social Security Number. Make sure you haven't transposed numbers, mistakenly filled in a date or phone number, etc.
  • Name - it is important that we have your name exactly as it is on your Social Security card. We require that name to issue payments.
  • Dates - make sure you've filled in correct dates (not mistaking birthdates for date of last employment, etc.)
  • Signatures - make sure all necessary signatures are included. In addition to the member's signature, some forms require a signature from a spouse, Notary Public, or authorized administrative representative.

Before submitting the form, make a copy for your records. Send or deliver the form as directed in the instructions for the form. Some forms go to PERSI, others to the employer, and some go to Xerox HR Solutions. Please be careful to send the form to the right place or processing will be delayed.

Other forms may be obtained by calling PERSI at 1-800-451-8228 or 208-334-3365 or by e-mailing Member Services

Forms for Active Members PDF Online
RS102 Membership Application
Download PDF Form
 
RS108 Request for Base Plan Account Withdrawal with Special Tax Notice
Download PDF Form
 
RS110 Address Change
Download PDF Form
 
RS111 Member Name Change
Download PDF Form
Submit Form Online
RS113 PERSI Durable Limited Power of Attorney
Download PDF Form
 
RS115 Beneficiary Designation
Download PDF Form
Submit Form Online
RS451 Release of Information
Download PDF Form
 
RS451A Release of Account Information By Spouse or Former Spouse
Download PDF Form
 
RS801 Choice 401(k) Plan Deferral Election Form
Download PDF Form
 
RS802 Choice 401(k) Plan Investment Election Worksheet
Download PDF Form
 
RS803 Request to Contribute Rollover Funds to the Choice 401(k) Plan
Download PDF Form
 
RS1000 Retirement Application Kit (RS121, RS322, RS448, and RS115)
Download PDF Form
 
To request a Choice 401(k) Plan Enrollment Kit, please e-mail us: Request an Enrollment Kit
To request a loan from your Choice 401(k) Plan logon to your account and go to the "Actions" tab or call Xerox at 1-866-437-3774.
Alternate Social Security Card Evidence
Download PDF Form
 
Alternate Date of Birth Evidence
Download PDF Form
 
Forms for Inactive Members PDF Online
RS108 Request for Base Plan Account Withdrawal with Special Tax Notice
Download PDF Form
 
RS110 Address Change
Download PDF Form
Submit Form Online
RS111 Member Name Change
Download PDF Form
Submit Form Online
RS113 PERSI Durable Power of Attorney
Download PDF Form
 
RS115 Beneficiary Designation
Download PDF Form
Submit Form Online
RS451 Release of Information
Download PDF Form
 
RS451A Release of Account Information By Spouse or Former Spouse
Download PDF Form
 
RS802 Choice 401(k) Plan Investment Election Worksheet
Download PDF Form
 
RS807 Choice 401(k) Plan Request for Death Benefit Payment
Download PDF Form
 
RS813 Choice 401(k) Plan Request for Installment Payments
Download PDF Form
 
Withdrawal requests are processed by Xerox HR Solutions, the record keeper. Logon to your account and go to "Actions" or call Xerox at 1-866-437-3774.
Special Tax Notice Regarding Plan Payments
Download PDF Form
 
Forms for Firefighter Retirement Fund (FRF) Members PDF Online
RS621F FRF Firefighter Retirement Application
Download PDF Form
Submit Form Online

Looking for other forms? go to Employers or Retirees for more forms