Retired Member Forms

It is crucial that you keep SERS up-to-date and provide us with your current mailing address-even if you use direct deposit-and accurate beneficiary information, if appropriate.

Please take great care in managing your retirement benefit. Do not complete a form that you do not understand. If you have any questions, please call 1.800.633.5461 and a SERS professional will assist you. When you do complete a form, please ensure that it is 100% complete, accurate, and accompanied by appropriate supporting documentation, if necessary.

Some forms, such as retirement option change applications, must be completed with the assistance of a SERS retirement counselor. Other forms, such as domestic relations orders or powers of attorney, require a third-party to complete, such as a court or a notary. Many members have told us that it is extremely helpful to see these types of forms and to be able to gather required information prior to being asked to complete them. Thus, this page provides sample copies of many forms for your information.

Most Common Forms
Retirement Option Changes
Retiree Health Program

Your SERS retirement counselor can assist with all Enrollments and Change Forms. For information about your specific health plans or coverage, please contact PEBTF at

Death Benefits

If you are looking for a form not provided above, check the forms page for active members.

SERS provides forms in PDF format. If your computer is not equipped to access PDF files, you can download a free copy of Adobe Reader or you can call 1.800.633.5461 and we'll gladly send whatever you need.

You can return completed forms to:

Pennsylvania State Employees' Retirement System
30 North 3rd Street, Suite 150
Harrisburg, PA 17101


Fax: 717.237.0346