LIST OF ALL FORMS

Form no.	Form Description
11S 11S-Monthly Remittan...	11S-Monthly Remittance of Fees for the Registers of Deeds' Supplemental Pension Fund
170 170-Authorizing Dire...	170-Authorizing Direct Deposit
170S 170S-Survivor's ...	170S-Survivor's Benefit: Authorizing Direct Deposit
170TB 170TB-Authorizing Di...	170TB-Authorizing Direct Deposit for the Transfer Benefit
237 237-Reporting Your 2...	237-Reporting Your 2023 Income To Continue Your Retirement System Disability Benefit
253 253-Reporting an Emp...	253-Reporting an Employee's Work Record In the Event of Death
276 276-Designating Bene...	276-Designating Beneficiary(ies) for the Separate Insurance Benefit Plan for Law Enforcement
290 290-Choosing Income ...	290-Choosing Income Tax Withholding Preferences - (Update Online in ORBIT)
290401K 290401K-Choosing 401...	290401K-Choosing 401K Income Tax Withholding Preferences
290457 290457-Choosing 457 ...	290457-Choosing 457 Income Tax Withholding Preferences
290S 290S-Survivor's ...	290S-Survivor's Benefit: Choosing Income Tax Withholding Preferences
296 296-Reporting Your 2...	296-Reporting Your 2023 Income To Continue Your Benefit Through the Disability Income Plan
297 297-Reporting Your 2...	297-Reporting Your 2023 Income to Continue Your Disability Salary Continuation Plan Benefit
2C 2C-Designating Benef...	2C-Designating Beneficiary(ies) - (Update Online in ORBIT)
2FR 2FR-Designating Bene...	2FR-Designating Beneficiary(ies) for the Firefighters' and Rescue Squad Workers' Pension Fund
3 3-Declining to Parti...	3-Declining to Participate in the Local Governmental Employees' Retirement System
316 316-Pink Sheet Refun...	316-Pink Sheet Refund
319401K 319401K-Choosing to ...	319401K-Choosing to Transfer NC401(k) Plan Contributions for an Additional Monthly Benefit
319457 319457-Choosing to T...	319457-Choosing to Transfer NC Deferred Compensation (457) Plan Contribs for an Additional Monthly Benefit
319LEO 319LEO-Choosing to T...	319LEO-Choosing to Transfer NC401(k) Plan Contributions for an Additional Monthly Benefit for LEOs
333BEN 333BEN-Designating B...	333BEN-Designating Beneficiary(ies) for the Contributory Death Benefit for Retired Members
333SAMPLE 333SAMPLE-Choosing t...	333SAMPLE-Choosing the Contributory Death Benefit for Retired Members
336 336-Designating Bene...	336-Designating Beneficiary(ies) for the Guaranteed Refund as a Retiree
336401K 336401K-Designating ...	336401K-Designating Beneficiary(ies) for the 401K Guaranteed Refund
336457 336457-Designating B...	336457-Designating Beneficiary(ies) for the 457 Guaranteed Refund
348 348-Requesting Leave...	348-Requesting Leave of Absence in the Firemen's and Rescue Squad Workers' Pension Fund
349 349-Purchasing Pensi...	349-Purchasing Pension Fund Credit for Prior Fire or Rescue Service
350 350-Enrolling in the...	350-Enrolling in the Firefighters' and Rescue Squad Workers' Pension Fund
359 359-Transferring Acc...	359-Transferring Accounts in the Firefighters' and Rescue Squad Workers' Pension Fund
398 398-Using A Distribu...	398-Using A Distribution of Tax-Sheltered Savings to Purchase Retirement Credit
4 4-Certification of L...	4-Certification of Local Government Service
430 430-Purchasing Retir...	430-Purchasing Retirement Credit for a Period of Interrupted Service Related to Parental Leave
441 441-Purchasing Retir...	441-Purchasing Retirement Credit for a Period of Workers’ Compensation
443 443-Purchasing Retir...	443-Purchasing Retirement Credit for State or Local Government Temporary Employment
451 451-Purchasing Retir...	451-Purchasing Retirement Credit for a Period of Part-Time State or Local Government Employment
452 452-Purchasing Retir...	452-Purchasing Retirement Credit for a Period of Service with a Non-Participating Local Unit
455 455-Purchasing Retir...	455-Purchasing Retirement Credit for a Period of Out-of-State Employment
461 461-Purchasing Retir...	461-Purchasing Retirement System Credit for Withdrawn Service
462 462-Purchasing Retir...	462-Purchasing Retirement System Credit for Military Service
463 463-Purchasing Retir...	463-Purchasing Retirement Credit for a Period of Interrupted Service for Educational Purposes
463F 463F-Requesting Cont...	463F-Requesting Continuation of Contributions and Credit for Planned Educational Leave
466 466-Purchasing Retir...	466-Purchasing Retirement System Credit for Unreported Service Omitted Through Error
467 467-Purchasing Retir...	467-Purchasing Retirement System Credit for a Period of Federal Service
470 470-Purchasing Retir...	470-Purchasing Retirement Credit for a Waiting Period Imposed by a Local Unit
478 478-Purchasing Retir...	478-Purchasing Retirement System Credit for Withdrawn Optional Retirement Program Service
485 485-Purchasing Retir...	485-Purchasing Retirement Credit for a Period of Interrupted Service Due to Extended Illness
499 499-Purchasing Retir...	499-Purchasing Retirement Credit for a Period of Service with a Non-Participating Charter School
5 5-Withdrawing Your R...	5-Withdrawing Your Retirement Service Credit and Contributions
5FR 5FR-Withdrawing Cont...	5FR-Withdrawing Contributions from the Firefighters' and Rescue Squad Workers' Pension Fund
5TR 5TR-Transferring Ser...	5TR-Transferring Service and Contributions Between Systems
6 6-Claiming Your Reti...	6-Claiming Your Retirement Benefit
641 641-Public School Un...	641-Public School Unit Certification
6C 6C-Reporting an Empl...	6C-Reporting an Employee's Work Record for Retirement
6ERSAMPLE 6ERSAMPLE-Authorizin...	6ERSAMPLE-Authorizing Your New Spouse As Beneficiary
6ESAMPLE 6ESAMPLE-Sample 6E C...	6ESAMPLE-Sample 6E Choosing Your Retirement Payment Option
6FR 6FR-Retiring from th...	6FR-Retiring from the Firefighters' and Rescue Squad Workers' Pension Fund
6SABSAMPLE 6SABSAMPLE-Choosing ...	6SABSAMPLE-Choosing the Survivor's Alternate Benefit
7 7-Requesting Disabil...	7-Requesting Disability Retirement Benefits
700 700-Required Employe...	700-Required Employer Information
701 701-Requesting the S...	701-Requesting the Short-Term of Benefits through the Disability Income Plan of North Carolina
703 703-Medical Report f...	703-Medical Report for Eligibility Review of Short-Term Disability Benefits
704 704-Requesting Addit...	704-Requesting Additional Benefits through the Disability Income Plan of North Carolina
705 705-Agreeing to Acce...	705-Agreeing to Accept Long-Term Benefits through the Disability Income Plan of N.C.
706 706-Confirming an Em...	706-Confirming an Employee's Resignation
707 707-Reporting Earnin...	707-Reporting Earnings Monthly While Receiving Extended Short-Term or Long-Term Benefits
710 710-Employer's W...	710-Employer's Worksheet for Determining the Waiting Period Before the Short Term Begins
711 711-Determining the ...	711-Determining the Maximum Monthly Benefit During the Short Term
712 712-(Optional) Deter...	712-(Optional) Determining the Affect of Other Benefits on the Short-Term Benefit
713 713-(Optional) Deter...	713-(Optional) Determining the Short-Term Benefit for Partial and Special Months
714 714-Employer's P...	714-Employer's Payment Record, Reimbursement Calculation, and Service Credit Report
717 717-Employer Bank Ch...	717-Employer Bank Change Request Form
7A 7A-Medical Report fo...	7A-Medical Report for Disability Eligibility Review
7AR 7AR-Medical Report f...	7AR-Medical Report for Re-exam
7E 7E-Choosing Your Dis...	7E-Choosing Your Disability Retirement Payment Option
7FR 7FR-Requesting Disab...	7FR-Requesting Disability Status from the Firefighters' and Rescue Squad Workers' Pension Fund
ACCTMIDAFF ACCTMIDAFF-Affidavit...	ACCTMIDAFF-Affidavit of Identity
COA COA-Updating Your Ad...	COA-Updating Your Addresses or Name
CONCHG CONCHG-Employer Cont...	CONCHG-Employer Contact Update Request
DB228 DB228-Choosing Tax T...	DB228-Choosing Tax Treatment for a Payment of Undistributed Contributions Due to a Death
ERRWK ERRWK-Correcting an ...	ERRWK-Correcting an Employee's Payroll Record
ESRR ESRR-Re-Employment W...	ESRR-Re-Employment Worksheet for Retirees Returning to Work
HMONLINE HMONLINE-Instruction...	HMONLINE-Instructions for Changing Retiree Health Coverage Through the State Health Plan Online
MR MR-Authorizing the R...	MR-Authorizing the Release of Medical Records
ORP ORP-Certifying Optio...	ORP-Certifying Optional Retirement Program (ORP) Service Credit Under TSERS Reciprocity Provisions
SUP SUP-The Supplemental...	SUP-The Supplemental Retirement Plans
SVC SVC-Reviewing Your S...	SVC-Reviewing Your Service Record and Requesting an Audit of Your Service Credit