California Public Employees' Retirement System Forms

This document provides a summary of health benefits available to residents in California, including information about coverage, costs, and important plan details.

This document provides a summary of health benefits offered in California. It outlines the different types of coverage available, as well as the costs and benefits associated with each plan. It is a useful resource for understanding the health insurance options in California.

This form is used for authorizing direct deposit of payments in the state of California.

This document allows individuals in California to designate a custodian for a minor under the California Uniform Transfers to Minors Act.

This Form is used for the purpose of declaring and providing evidence of marriage or domestic partnership in the state of California. It is used to confirm the legal status of a marriage or domestic partnership.

This form is used for affirming the OPEB (Other Post-Employment Benefits) cost analysis report in the state of California. It helps analyze the costs associated with providing post-employment benefits to public employees.

This Form is used for authorizing address changes in California.

This form is used for establishing the parent-child relationship in the state of California.

This form is used for requesting disbursement of retiree benefits from the California Employers' Retiree Benefit Trust.

This Form is used for certifying impairment of a Memorandum of Understanding (MOU) in California.

This form is used to certify an individual's Medicare status in the state of California. It is necessary for determining eligibility for certain healthcare benefits and services.

This document certifies the OPEB actuarial information in the state of California. It ensures the accuracy and validity of the actuarial calculations for Other Post-Employment Benefits (OPEB) provided to public employees in California.

This form is used for certifying compliance with OPEB funding policy and GASB OPEB standards reporting in the state of California.

This form is used by retirees in California to make an election regarding their Cobra coverage.

This Form is used for authorizing direct payment in California.

This form is used for verifying the dependency status of individuals for various purposes in the state of California. It is typically required when proving the eligibility of dependents for benefits or tax purposes.

This type of document explains how the distribution of Judges' Retirement System II (JRS II) contributions or monetary credits is calculated in California. It also includes information on the required minimum distribution (RMD) for such contributions.

This Form is used for electing optional membership as an elected officer in California for CalPERS pension system.

This form is used for the election of optional membership for legislative employees in the state of California for CalPERS.

This Form is used for California State Appointees to make an election for optional membership with CalPERS retirement system.

This form is used for Part-Time Employees in California to elect optional membership in CalPERS.

This document is used in California to authorize the use of the Automated Clearing House (ACH) method for making electronic payments.

This Form is used for the election of optional membership for California National Guard members in the California Defense Mobilization Committee (DMC).

This Form is used for the distribution of funds from the Judges' Retirement System (JRS) Extended Service Incentive Program (ESIP) Required Minimum Distribution (RMD) in California.

This Form is used for employers in California to request an estimate for disability allowance for their employees.

This form is used for the First Tier Future Election Package in California. It provides information and instructions for future elections.

This Form is used for enrolling in the Health Benefits Plan for retirees and survivors in California. It provides instructions for completing the enrollment process.

This Form is used for enrolling in a health benefits plan for active employees in California. It provides instructions on how to complete Form HBD-12.

This document describes the circumstances under which someone in California may be ineligible for Medicare certification.

This form is used for providing survivor and beneficiary information for the Judges' Retirement System in California.

This form is used for judges in California who are applying for service retirement.