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.
The Choice 401(k) Plan accepts rollover contributions from other qualified retirement plans. Instructions and additional information are included with the form to guide you through the process.
Use this form to request to receive your distribution of funds from the Choice 401(k) Plan. If you are a beneficiary of a deceased participant, use the Choice 401(k) Plan Death Benefit Claim Request.
Use this form to certify you are a beneficiary of a deceased Choice 401(k) Plan participant and to request payment of the deceased participant's Choice 401(k) Plan funds. Instructions and important tax information are included with the form.
Use this form to certify you are a beneficiary of a deceased Choice 401(k) Plan participant and to request payment of the deceased participant's Choice 401(k) Plan funds. Instructions and important tax information are included with the form.

Helping Idaho Public Employees Build A Secure Retirement

PERSI Retiree 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.

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 the record keeper. 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 Retirees PDF
RS110 Address Change Download PDF Form
RS111 Member Name Change Download PDF Form
RS113 PERSI Durable Limited Power of Attorney Download PDF Form
RS115 Beneficiary Designation Download PDF Form
RS162 Public Safety Officer Authorization for Insurance Premium Deduction Download PDF Form
RS322 Federal and Idaho State Tax Withholding Selection Download PDF Form
RS448 Direct Deposit Authorization Download PDF Form
RS451 Release of Information Download PDF Form
RS451A Release of Account Information By Spouse or Former Spouse Download PDF Form
RS430 Retired Public Safety Officer Insurance Carrier Agreement Download PDF Form
Choice 401(k) Plan Death Benefit Claim Request Download PDF Form
Choice 401(k) Plan Incoming Rollover Request Download PDF Form
Choice 401(k) Plan Separation from Employment Withdrawal Request Download PDF Form