Beneficiary

• Beneficiary Designation form (ABP/DCRP)
• Beneficiary Designation Form (JRS)
• Beneficiary Designation Form (SACT)
• Retired Member Beneficiary Designation (PERS/TPAF/PFRS/SPRS)

Direct Deposit

• Authorization for Direct Deposit

Member Information

• Affidavit of Name Change
• Change of Address Form (all funds)
• Waiver or Restoration of Pension Allowance

Tax Withholding

• Retired Federal Tax Withholding Form W-4P
• Retired New Jersey Tax Withholding Form NJ-W-4P

Claim/HIPAA forms

• Aetna plan claim forms - contact Aetna directly
• Member Authorization Form for Use and Disclosure of Protected and Private Information
• NJ DIRECT Claim Form

Dental

• Retiree Dental Plan Application

Disability

• State/Local Government Retiree Disability Application (SHBP)
• Education Retiree Disability Application (SEHBP)

High Deductible

• Retiree Health Benefit Enrollment and/or Change Form for High Deductible Plans (Local Education)
• Retiree Health Benefit Enrollment and/or Change Form for High Deductible Plans (State and Local Government)

Medicare-Eligible

• Medicare & You
• Medicare Requirements and Notice
• Medicare Eligible Retiree Health Benefit Enrollment and/or Change Form (Local Education)
• Medicare Eligible Retiree Health Benefit Enrollment and/or Change Form (State and Local Government)

Non-Medicare

• Non-Medicare Retiree Health Benefit Enrollment and/or Change Form (Local Education)
• Non-Medicare Retiree Health Benefit Enrollment and/or Change Form (State and Local Government)

Wellness

• NJ DIRECT Annual Retiree Wellness Certification
• Retiree Wellness Program Pledge for Healthy Living
• SHBP Retiree Wellness Program Information

Miscellaneous

• Application for Chapter 375 Coverage
• Cancel/Decline/Waive Retired Coverage Form
• Dental: NJ State Dental Expense Plan Claim Form
• Retiree Tax Certification - Domestic Partner Benefit

Death Claims

• Employer Certification (ABP/DCRP)
• Employer Certification (PERS/TPAF/PFRS/SPRS)

Enrollment

• ABP Participation Waiver
• DCRP Transmittal of Local Government Ordinance or Resolution
• DCRP Waiver of Retirement Program Participation for Employees Enrolled in the PERS or TPAF (for PERS and TPAF Members Earning Salary in Excess of the Social Security Maximum)
• Election to Participate in the DCRP for PERS or TPAF Employees Who Previously Waived DCRP Enrollment
• Employee/Independent Contractor Checklist (PERS/DCRP)
• Enrollment Application (ABP)
• Enrollment Application (DCRP)
• Enrollment Application (JRS)
• Enrollment Application (PERS/TPAF)
• Enrollment Application (PFRS)
• Enrollment Application (SPRS)
• Enrollment/Transfer Application (ABP)
• Interfund Transfer Form (PERS/TPAF/PFRS/SPRS/JRS)
• Intrafund Transfer/Rehire Form (ABP)
• Intrafund Transfer/Rehire Form (DCRP)
• PERS - Prosecutors Part Change of Position Form (for County Prosecutors)
• PERS - Prosecutors Part Change of Position Form (for State Prosecutors)
• PERS - Prosecutors Part Change Form - Government Employee Interchange Act
• PFRS Report of Examining Physician
• Report of Transfer/Multiple Enrollment (PERS/TPAF/PFRS)
• Resolution: County Fire Marshals and Assistant County Fire Marshals

Group Life Insurance

• GLI: Contributory Life Insurance: Withdrawal Form (PERS)
• GLI: Contributory Life Insurance: Withdrawal Form (TPAF)

IROC/TEPS

• Completing the Report of Contributions
• Delinquent Notice
• IROC User Guide
• Sample Payroll Certification of Payroll Deductions
• Sample Report Of Contributions
• Sample Salary Sheet
• TEPS Authorization
• TEPS Authorization (Fill in and Print, Acrobat 4.0, or Higher Needed)
• TEPS Procedure Guide
• TEPS Shortage Transmittal Instructions

Loans

• Certified Loan Request
• Loan Recertification

Purchase

• Employer Verification of Leave of Absence for Union Representation
• Employment Verification Form
• Request for USERRA-Eligible Service

Retirement

• Certification of Service and Final Salary (PERS/TPAF)
• Certification of Service & Final Salary (PFRS)
• Certification of Service & Final Salary (SPRS)
• Employer Certification for Disability Retirement
• Notification of Employment after Retirement
• Report of Temporary Disability Insurance

SACT/ACTS

• Salary Reduction Agreement (ACTS)
• Salary Reduction Agreement (SACT)

Terminations/Withdrawals

• Eligibility Status Change Verification Form (DCRP)
• Leave of Absence/Termination of Employment (ABP)
• Report of Unemployment Insurance, etc.
• Withdrawal Certification

Miscellaneous

• EPIC User's Information Guide
• Non-Veteran Elected Officials Roster
• Salary Reduction Agreement (ABP)
• Supplemental Biweekly Certification
• VESP Application

COBRA/Chapter 375

• Application for Chapter 375 Coverage
• COBRA Application for PPO, HMO, and Tiered Plans (State and Local Government Employees)
• COBRA Application for PPO and HMO Plans (Local Education Employees)
• COBRA Application for High Deductible Health Plans (State, Local Government, and Local Education Employees)
• Notice to Employees

Dental

• Dental Application
• Dental: Resolution for SHBP Dental Plan Participation
• Dental: Resolution for SHBP Dental Plan Termination

Participation/Termination of Benefits

• Deletion Transmittals Form with Instructions
• HSA Contribution Form for Centralized Payroll Employees
• HSA Contribution form for other State Employees, Local Government, and Local Education Employees
• Monthly Change Summary
• Resolution: Authorization to Participate in SHBP/SEHBP
• Resolution: Authorize Participation for Domestic Partnership Coverage under the SHBP/SEHBP
• Resolution: Limit the Medical Plans Offered under the SEHBP (Local Education)
• Resolution: Limit the Medical Plans Offered under the SHBP (Local Government)
• Resolution: Rx Participation
• Resolution: Terminate Participation in SHBP/SEHBP
• Resolution: Terminate Rx Participation
• Waiver/Reinstatement of Benefits (Local Government/Education Employees)

PPO, HMO, HD, and Tiered Plans

• Application for High Deductible Health Plans (Local Education)
• Application for High Deductible Health Plans (Local Government)
• Application for High Deductible Health Plans (State Active)
• Application for PPO and HMO Plans (Local Education)
• Application for PPO, HMO, and Tiered Plans (Local Government)
• Application for PPO, HMO, and Tiered Plans (State Active)

Miscellaneous

• Employee Tax Certification - Domestic Partner Benefit
• HIPAA: Certificate of Coverage
• Chapter 330 Employer Certification for Health Benefits
• Chapter 48 Employer Certification for Health Benefits
• Retiree Certification of Coverage (for Emergency Room)
• Resolution: Domestic Partner Health Benefits through a Non-SHBP Employer
• Resolution: Premium Delay
• Resolution: Change in Full Time Hours
• Resolution: Authorization to Change the Percent of Premiums Paid for Employee and/or Dependent Coverage by Local Employer
• Resolution: Chapters 88 & 436
• Resolution: Chapter 48 with Instructions
• Roster of Employees