Forms and Publications

Select from a list of some of the most frequently used publications and forms, which are available for you to print. If you need a form that is not available here, contact us to request a copy. 

Forms

Employers

• R4286G - MDOC Retiree Certification
  Retiree of the State Employees Retirement System who is receiving a state of Michigan pension and was subsequently rehired directly by the MDOC for the primary purpose of providing for the custody of individuals under the jurisdiction of the MDOC under the provisions of PA 217 of 2022.
 
• R0962G - New Hire & Rehire Benefit Overview (P.A. 264 of 2011)   
  Information to assist Human Resources offices regarding benefits for new hires and rehires.
     
• R0792G - Retiree Rehire Certification
  Retirees of the State Employees Retirement System who become employed by the State of Michigan as an employee, independent contractor, or through a contractual arrangement with another party, must forfeit their state pension for the duration of the reemployment. Hiring agencies who are considering employing an affected retiree must have the retiree complete section 1 of the Retiree Rehire Certification (R0792G) at time of hire. The hiring agency should complete section 2 and then return the form to ORS.
   
• R1088G Retirement Benefits Waiver
  Elected or appointed officials who are not members of a state board, commission, or council and receive a per diem rate use this form to revoke participation in the Tier 2 defined contribution plan.
   
• R03469G – Department of Health and Human Services (DHHS) Retiree Rehire Certification
  Retirees of the State Employees Retirement System who are rehired by DHHS to provide mental health services as a Psychiatrist or mental health professional, in psychiatric hospitals operated by DHHS under the provisions of 2016 PA 524 and 2020 PA 18.
   
• R03470G – Department of Natural Resources (DNR) Retiree Rehire Certification  Retirees of the State Employees Retirement System who are rehired by DNR to suppress active wildfires under the provisions of 2016 PA 351.
   
• R03471G – Department of Corrections (DOC) Retiree Rehire Certification Former Department of Corrections retirees who are rehired by DOC through a contract with another party to provide telecommunications services to DOC, for the primary purpose of collecting or analyzing intelligence generated within the Department under the provisions of 2020 PA 314.

Employees

Below is a list of forms that employees may need your assistance when completing.

• R0400G - Defined Benefit Plan Beneficiary Nomination  
  Defined benefit plan employees use this form to change beneficiary information.
   
• R0654G - Supplemental TDP Agreement
  For Defined Benefit plan employees who wish to have a permanent additional tax-deferred payroll deduction added to an existing payroll deduction. 
   
• R0518G - Payoff Payment Options for a TDP Agreement
  A Defined Benefit plan employee, who is retiring or terminating employment, should use this form to payoff their TDP agreement.

For a complete list of forms available for employees go to the State Employees website.

Publications/Posters

The publications/posters below are reviewed and published annually. When ordering a bulk supply, please order enough for your immediate needs to ensure that you always have the most current version

• Preretirement Orientation
  For Defined Benefit plan members who are within a few years of retiring. This book contains specifics on how pensions are calculated, the various payment options, how to prepare for retirement, and the application process. 
   
• After_Retirement
  Members will receive this booklet when they apply for their pension. It tells them what to expect, and how and when they should contact ORS after their retirement benefits begin.
   
• If You Become Disabled: State Disability Protection
For Defined Benefit members who are facing an illness or injury that prevents them from working. This brochure defines the criteria to receive a disability benefit and gives an overview of the application process.