TESRS

Texas Emergency Services Retirement System

Forms & Publications

Annual Report Instructions - These instructions provide the steps for Local Boards to meet in February 2021 and award 2020 qualified service to members. A Local Board Meeting agenda template is also provided.


Form 602A-2021 - Annual Report of Local Board Membership and Authorized Users: Use this form to report your Local Board membership. At your February meeting of your Local Board, elect officers, review the TESRS Security Policy, and authorize two people to have access to the Department's information in TESRS Online (TOL), the pension system's database.


Required Reports: Written Request for Waiver of Administrative Penalty - The Local Board or the Chief of the Department may use this form to submit a request to the TESRS Executive Director to waive the administrative penalties assessed because a required report was not submitted by the due date for the report. The form includes a copy of the TESRS rule 34 TAC 310.9 which requires the assessment of penalty and the option to request a waiver.


Form 502 - Personnel Record - this form is completed by each member of the department and signed by the head of the department.


Form 504 - Termination Record - this form is completed by the department head to terminate members from enrollment in the pension fund.


Form 610 - Designation of Alternative Participating Department Head - The governing body of a participating department may formally designate someone other than the Chief to enroll and terminate members in TESRS by completing and submitting a Form 610 – Designation of Alternative Participating Department Head.


Form 503 - Member Information Update – this form is used by active members (not retirees) if they need to update their contact information and/or beneficiaries.

TESRS Security Policy - TESRS Security Policy to protect the confidentiality of information about members, retirees, and beneficiaries.


TESRS Online Training Manual  - An overview of TESRS Online (TOL) database functions for authorized users.


TESRS Benefits Flyer - Information about the benefits provided to TESRS members, contributions made by governing entities, and contact information.


Membership Reconciliation Report Procedural Document - An overview of how authorized users complete an MRR in TOL.


Form PAC – Payee Address change – this form is used by retirees and spouses who want to change their personal information and banking information. 


Member Address Change - this form is used to update members' contact information.
 
Service Retirement Application – this form is the application that members fill out when they want to retire.  This form must accompany the IRS W-4P tax form (see next form)

TESRS Withholding Form -  Retirees and surviving spouses may use this form to replace the IRS W-4P.

IRS W-4P – this is the link to the IRS tax form completed by retirees and surviving spouse.


Direct Deposit Authorization – this form is used by retirees and spouses who wish to have their checks direct deposited or to change your existing direct deposit information.


Form 411-S1 – Surviving Spouse Annuity Application for Retiree Death – this is the form used by surviving spouse to apply for an annuity after a member has retired.This form must be accompanied by a copy of the death certificate and the applicants ID.


Form 411-S2 - Surviving Spouse Annuity Application for Member Death - this is the form used by a surviving spouse to apply for a member service or non-service death benefit annuity. This form must be accompanied by a copy of the death certificate and the applicant's ID. 


Form 411-S3 - Surviving Dependent Annuity Application for Member Death - this is the form used for a dependent child to apply for an annuity when a member service death benefit annuity. This form must be accompanied by a copy of the birth certificate for the dependent.


Form SB-LODD: Application for Line of Duty Death Benefit - this is the form used for a beneficiary to receive a on duty death lump-sum benefit.


Form TDIS-APP: Temporary Disability Application - this form is used if a local board determines that a member became diabled during the performance of emergency services or support services and is unable to return to work at member's regular occupation or, if the member is a student, is unable to return to the member's scholastic duties.


Form 200-B – Contribution Changes - this form is used by the department and Local Board to authorize a change in the contribution rate.  Any changes to the rate must be pre approved by the governing entity.


Form 200-C – Retroactive Supplemental Contribution – this form is used to make a lump sum retroactive contribution and have it applied to the time period indicated.  


Form 200-D - Correction of Errors - this form is used by the local board to correct qualified service credit for its members.


Meeting Notice Template – this form is an example of a Local Board meeting notice to be publicly posted at least 72 hours in advance of the meeting date and time.  

 

Certification of Physical Fitness FAQ - this provides an overview of frequently asked questions about the requirements for certifications of physical fitness for TESRS.


Department ACH/Set up/Change – this form is used by governing entities to either set up their account or make changes to their account for contribution payments.

Model QDRO Form - Qualified Domestic Relations Order - This template is specific to TESRS benefits and must be used as the QDRO to assign any portion of TESRS benefits.

Form 603 - Governing Entity Contact Information - this form is used to provide information about the authorized signatory and financial personnel of the governing entity.

Form 603 Instructions - Instructions for Governing Entity Contact Information - this document provides instructions for completing Form 603.