Forms & Publications
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 602A - Annual Report of Local Board Membership and Authorized Users (with instructions).
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
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
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.