Retired Member Forms

Affidavit For Check Replacement
Click on this link to download a form if you are requesting a replacement check.

Change of Address Form
Electronic Funds Transfer / Direct Deposit Form
Take advantage of direct deposit today!
Just click on this link to download a form for your pension check to be deposited directly into your bank account quickly and safely each month.

FPPA Records Release Form
Click on this link to download a form to authorize FPPA to release information contained in you FPPA file.

W-4P Monthly Pension Distribution Form
Click on this link to download a form to change the amount of Federal and/or State taxes

Application for Change in Disability Status
This packet is for disability retirees who are applying for a change in disability status.
Forms for post-retirement distributions of:
SRA, Money Purchase Plan or the FPPA 457 Plan.
Click on the links below for applications to take distributions from your SRA, Money Purchase Plan or FPPA 457 Plan.
SRA Distributions

This packet is for former Statewide Defined Benefit Plan MEMBERS ONLY wishing to take an SRA distribution.
This packet is for members who have received FPPA Board approval for their disability retirement application or survivor benefits, and now wish to take an SRA distribution.
Money Purchase Plan Distribution
This packet is for former Money Purchase Plan MEMBERS ONLY and wishing to take a distribution.
FPPA 457 Plan Distribution
This packet is for FPPA 457 Plan MEMBERS ONLY and wishing to take a distribution.