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 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.
Confidentiality Agreement - Authorized users must read and certify this agreement in order to gain access to the TESRS online database.
TESRS Online Training Manual - An overview of TESRS Online (TOL) database functions for authorized users.
Membership Reconciliation Report Procedural Document - An overview of how authorized users complete an MRR in TOL.
Form 503 - Member Information Update – this form is used by
active members (not retirees) if they need to update their contact information
Form PAC – Payee Address change – this form is used by
retirees and spouses who want to change their personal information and banking
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 2018 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 – Survivor’s Annuity Plan – this is the form
used by surviving spouse to apply for the decedent’s benefits. This form must be accompanied by a copy of
the death certificate.
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 Error – this form is used by the local board to correct qualified service credit for its members.
Summary of Benefits Flyer - Informational flyer that lists all the benefits of the TESRS system, describes contributions, and provides contact information of our agency.
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.
Compliance Checklist – this is an informational form. It is used by departments and local boards as a self-assessment tool to check compliance with TESRS statutes and rules.
Physical Fitness FAQ - this provides an overview of frequently asked questions about the requirements for physical certifications in 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 602 - Local Board Membership - this form is used to provide information about the six members of the Local Board.
Form 602 Instructions - Instructions for Local Board Membership - this document provides instructions for completing Form 602
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.