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Kentucky Public Pensions Authority Forms

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Form 6260 Medicare Secondary Payer Application for Medical Insurance Reimbursement - Kentucky PDF

Form 6260 Medicare Secondary Payer Application for Medical Insurance Reimbursement - Kentucky
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Form 8030 Employer Job Description - Kentucky PDF

Form 8030 Employer Job Description - Kentucky
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Form 6756 Annual Employer Certification of Non-contributing Service Providers - Kentucky PDF

Form 6756 Annual Employer Certification of Non-contributing Service Providers - Kentucky
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Form 2014 Rejection of Nonhazardous Part-Time Participation - Kentucky PDF

Form 2014 Rejection of Nonhazardous Part-Time Participation - Kentucky
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Form 6017 (IRS Form W-4P) Withholding Certificate for Pension or Annuity Payments - Kentucky, 2021 PDF

Form 6017 (IRS Form W-4P) Withholding Certificate for Pension or Annuity Payments - Kentucky, 2021
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Form 8203 Social Security Certification - Kentucky PDF

Form 8203 Social Security Certification - Kentucky
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Form 4225 Verification of Past Employment - Kentucky PDF

Form 4225 Verification of Past Employment - Kentucky
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Form 4131 Verification of Urban-County Government Service - Kentucky PDF

Form 4131 Verification of Urban-County Government Service - Kentucky
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Form 4140 Verification of out of State Service - Kentucky PDF

Form 4140 Verification of out of State Service - Kentucky
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Form 6439 Qualified Domestic Relations Order - Alternate Payee Information - Kentucky PDF

Form 6439 Qualified Domestic Relations Order - Alternate Payee Information - Kentucky
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Form 6434 Pre-retirement Qualified Domestic Relations Order for Division of Marital Property - Kentucky PDF

Form 6434 Pre-retirement Qualified Domestic Relations Order for Division of Marital Property - Kentucky
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Form 6000 Notification of Retirement - Kentucky PDF

Form 6000 Notification of Retirement - Kentucky
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Form 8001 Certification of Application for Disability Retirement and Supporting Medical Information - Kentucky PDF

Form 8001 Certification of Application for Disability Retirement and Supporting Medical Information - Kentucky
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Form 8102 Employment and Medical Staff Review Certification Reinstatement - Kentucky PDF

Form 8102 Employment and Medical Staff Review Certification Reinstatement - Kentucky
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Form 6460 Special Power of Attorney - Kentucky PDF

Form 6460 Special Power of Attorney - Kentucky
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Form 8202 Workers' Compensation Certification - Kentucky PDF

Form 8202 Workers' Compensation Certification - Kentucky
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Form 8035 Employee Job Description - Kentucky PDF

Form 8035 Employee Job Description - Kentucky
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Form 2040 Change of Contact Information - Kentucky PDF

Form 2040 Change of Contact Information - Kentucky
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Form 4120 Verification of Employment With a State University - Kentucky PDF

Form 4120 Verification of Employment With a State University - Kentucky
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Form 4170 Direct Transfer/Rollover Authorization - Kentucky PDF

Form 4170 Direct Transfer/Rollover Authorization - Kentucky
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Form 6130 Authorization for Deposit of Retirement Payment - Kentucky PDF

Form 6130 Authorization for Deposit of Retirement Payment - Kentucky
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Form 6030 Death Benefit Designation - Kentucky PDF

Form 6030 Death Benefit Designation - Kentucky
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Form 6754 Member Reemployment Certification - Kentucky PDF

Form 6754 Member Reemployment Certification - Kentucky
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Form 6767 Appointment of Kentucky State Police School Resource Officer - Kentucky PDF

Form 6767 Appointment of Kentucky State Police School Resource Officer - Kentucky
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Form 6433 Authorization for Release of Information and Request for Information for Qualified Domestic Relations Order - Kentucky PDF

Form 6433 Authorization for Release of Information and Request for Information for Qualified Domestic Relations Order - Kentucky
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Form 4115 Federal Verification - Kentucky PDF

Form 4115 Federal Verification - Kentucky
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Form 6437 Qualified Domestic Relations Order for Payment of Child Support by an Administrative Agency - Kentucky PDF

Form 6437 Qualified Domestic Relations Order for Payment of Child Support by an Administrative Agency - Kentucky
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Form 6435 Post-retirement Qualified Domestic Relations Order for Division of Marital Property - Kentucky PDF

Form 6435 Post-retirement Qualified Domestic Relations Order for Division of Marital Property - Kentucky
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Form 6438 Qualified Domestic Relations Order for Payment of Alimony/Maintenance - Kentucky PDF

Form 6438 Qualified Domestic Relations Order for Payment of Alimony/Maintenance - Kentucky
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Form 6436 Qualified Domestic Relations Order for Child Support - Kentucky PDF

Form 6436 Qualified Domestic Relations Order for Child Support - Kentucky
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Form 6766 Appointment of Retired School Resource Officer - Kentucky PDF

Form 6766 Appointment of Retired School Resource Officer - Kentucky
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Form 6751 Employer Certification Regarding Reemployment - Kentucky PDF

Form 6751 Employer Certification Regarding Reemployment - Kentucky
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Form 6752 Employer Certification of Independent Contractor/Leased Employee - Kentucky PDF

Form 6752 Employer Certification of Independent Contractor/Leased Employee - Kentucky
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Form 6753 Employer Certification of Volunteer - Kentucky PDF

Form 6753 Employer Certification of Volunteer - Kentucky
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Form 8101 Employment and Medical Staff Review Certification - Kentucky PDF

Form 8101 Employment and Medical Staff Review Certification - Kentucky
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Form 6481 Employer Request for Post-determination of Bona Fide Promotion or Career Advancement - Kentucky PDF

Form 6481 Employer Request for Post-determination of Bona Fide Promotion or Career Advancement - Kentucky
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Form 4150 Certification of Employment - Hazardous Position - Kentucky PDF

Form 4150 Certification of Employment - Hazardous Position - Kentucky
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Form 4527 Certification by a qualified Public Safety Employee and Request for an Exception to the 10% Early Distribution Penalty in IRC Section 72(T) - Kentucky PDF

Form 4527 Certification by a qualified Public Safety Employee and Request for an Exception to the 10% Early Distribution Penalty in IRC Section 72(T) - Kentucky
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Form 4172 Notice of Intent to Transfer Lump-Sum Payment(S) to Qualified Employer Sponsored Plan - Kentucky PDF

Form 4172 Notice of Intent to Transfer Lump-Sum Payment(S) to Qualified Employer Sponsored Plan - Kentucky
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Form 6486 Authorization for Release of Retirement Account Information - Kentucky PDF

Form 6486 Authorization for Release of Retirement Account Information - Kentucky
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