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IMRF Forms by Number

Member Access eforms — Fast, Accurate, Secure

Our electronic forms guide you through each step quickly and easily, and they have built-in features to improve accuracy. Member Access is available 24 hours a day, seven days a week—and forms are securely and instantly transmitted to IMRF once you are completed.

Secure forms available in Member Access include:

Member Forms

  • Application for Refund (Form 5.10)
  • Application for Retirement (Form 5.20)
  • Designation of Beneficiary (Form 6.11)
  • Application for Reinstatement of Service Credit (Form 6.03)
  • Member Information Change (Form 6.20)
  • Application for Disability Benefits (Form 5.40)

Retiree Forms

  • Tax Withholding (Form W4-P)
  • Direct Deposit (Form 1199)
  • Designation of Beneficiary (Form 6.11A)
  • Annuitant Information Change (Form 620R)

Sign into Member Access or view list of forms to print and download below.


ALL IMRF FORMS BELOW ARE NOW ENTERABLE. You may open the PDF using Adobe Acrobat Reader, type in your information, print out your form, sign it, and either mail or fax your completed form to IMRF.

In order to view these documents online, you need a software application called Adobe Acrobat Reader.

Forms Index

Miscellaneous Forms

BF-20 - Pension Estimate Request (11/2010)
BW-60 - Distribution/Rollover Certification (Rev. 08/2014)
BW-6B - Distribution/Rollover Certification for non-spouse beneficiaries (05/2013)
BW-60Q-Distribution/Rollover Certification QILDRO (Rev. 08/2014)
CORR-TPP - Proof of Previous IMRF or Reciprocal Retirement System Participation (07/2013)
W4-P - Withholding Certificate for Pension or Annuity Payments (01/2014) (Can also be submitted via Member Access)
1199 - Direct Deposit Authorization Form (07/2007)
VARF - Voluntary Additional Contributions Refund Form (Rev. 01/2014)
QILDRO -Qualified Illinois Domestic Relations Order (QILDRO) Form (Rev. 03/2014)
QILDRO Consent - Consent to Issuance of QILDRO Form (2/2013)
QILDRO Court Calculation Order Form (Rev. 03/2014)
Freedom of Information Act Booklet (Rev. 09/2012)
Freedom of Information Act Request Form (07/2011)
TR-6 - Application for the issuance of a replacement check for lump sum benefit payments (8/1998)
A-19 - Application for transfer of employee contributions to Police Pension Fund (Rev. 8/2014)
Social Security Administration -Form 1945 - Statement Concerning Employment in a Job Not Covered by Social Security (Links to the Social Security website)
A-20 - Application for transfer of employee contributions to Fire Pension Fund (5/2012)
Enrollment-Check List: Should this employee be enrolled in IMRF? ENTERABLE (12/2012)
Participation-Check List for Authorized Agents (12/2012)
Retirement -Check List for Authorized Agents (12/2012)
Disability -Check List for Authorized Agents (12/2012)
Termination -Check List for Authorized Agents (12/2012)
Death -Check List for Authorized Agents (12/2012)

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Form Series No. #1

1.55 - Suggested form of resolution to adopt IMRF SLEP for airport police (05/2013)
1.56 - Suggested form of resolution to adopt IMRF SLEP for forest preserve police (05/2013)
1.70 - Certificate of Dissolution—Annexing School Districts (Rev. 08/2014)
1.72 - Certificate of Dissolution—Annexation Unit of Government (01/2008)


Form Series No. #2

2.20 - Notice of Appointment of Authorized Agent (Rev. 11/2013)
2.30 -
Form obsolete. Use form 2.20
2.50 - Forms/Publications Request (02/2011)
2.80 - Employer Access User ID Form Obsolete, Click here to register for an account
2.90 - Freedom of Information Act Information Request Form (01/12)

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Form Series No. #3

3.00 - IMRF Electronic Funds Transfer (EFT) Enrollment Form (5/2003)
3.01 - Change Account for Electronic Payments from IMRF (820/06)
3.20 - Employer's Report of Adjustments to IMRF Earnings
Submit adjustments to IMRF earnings via Employer Access
3.22 - Request for Pension Impact Statement (P.A. 97-0609) (03/2012)

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Form Series No. #5

5.10 - Application for Separation Refund (01/2013) (Can also be submitted via Member Access)
5.10B - Previously Taxed Rollover Request (01/2008)
5.20 - Application for Retirement Annuity (06/2012) (Can also be submitted via Member Access)
5.20R - Application for Special Needs (Reversionary) Annuity (06/2013)
5.21 - Member's Notice of Intent to Retire Under ERI (01/2013)
5.30 - Application for Death Benefit (07/2011)
5.40 - Member's Application for Disability Benefits (06/2012)
(Can be submitted via Member Access)
5.41 - Employer Statement - Disability Claim (02/2013) (Submit the statement of disability via Employer Access)
5.42 - Physician Statement -Disability Claim (05/2011)
(Form 5.42 is for NEW disability claims ONLY. Do NOT use this form to update medical information for an ongoing claim. Contact IMRF for the CORRECT FORM to submit medical information for an ongoing claim.)
5.45 - Employer's Notice of Termination of Disability of Trial Work Period (05/2013)
5.47 - Authorization to View Records (02/2013)
5.60 - Application to serve as Representative Payee for Annuitant (10/2012)
5.63 - Application to serve as Representative Payee for Annuitant by Nursing Home or Hospital (10/2012)

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Form Series No. #6

6.01 - Request for Rollover Approval for Past Service (06/2012)
6.01E - Request for Rollover Approval for the Early Retirement Incentive (ERI) (04/2012)
6.02J - Application for Military Service Credit (09/2007)
6.03 - Application for Reinstatement of Service Credit (01/2013)
(Can also be submitted via Member Access)
6.04 - Application for Retroactive Service Credit (Rev. 11/2013)
6.05 - Omitted Service Credit Verification (11/2010)
6.06 - Conversion of Regular or SLEP Service Credit to Elected County Official (ECO) Service Credit (02/2008)
6.07 - Application for Prior Service Credit (12/2010)
6.09 - Conversion of Regular Service Credit to SLEP Service Credit (03/2012)
6.10 - Notice of Enrollment in IMRF

Submit a member's enrollment in IMRF via Employer Access
6.11 - Designation of Beneficiary (06/2012) (Can also be submitted via Member Access)
6.11A - Designation of Beneficiary for Annuitants (06/2012) (Can also be submitted via Member Access)
6.19 - Member Employment Information
Submit changes to a member's employment information through Employer Access
6.20 - Member Information Change (Rev. 08/2013)

The fastest and easiest way for members to submit information changes is through Member Access
Employers must submit information changes through Employer Access

6.21 - Election to Participate for Qualifying Position (07/2014)
6.21b - Election by Elected County Official to Participate in IMRF Elected County Official Plan (02/2012)
6.22 - Election of Police Chief to Participate as a SLEP Member (8/2012)
6.23 - Election to Contribute Under Additional Position (6/1999)
6.24 - 40-Year Service Election to Cease Contributions (02/2012)
6.28 - Revocation of Election to Participate in Elected County Official Plan (05/2013)
6.30 - Election to Make/Change Voluntary Additional Contributions (Rev. 02/2014)
6.32 - IMRF Benefit Protection Leave (02/2013)
6.33 - Out-of-State Service Credit Authorization (06/2009)
6.34 - Application by a Member of the General Assembly... (06/1998)
6.38 - ECO Conversion Analysis/Estimate Request (03/2010)
6.41 - Termination of IMRF Participation

Submit a member's termination of participation via Employer Access
6.62 - Resolution - Military Leave Authorization (08/2004)
6.62a - Resolution - To Allow LIMITED Service Credit for Military Leave that INTERRUPTED IMRF Participation (02/2004)
63A - Resolution - Military Service Credit (08/2007)
6.64 - Resolution - Elected Officials (03/2012)
6.64T - Resolution - Termination of Participation by Elected Officials (03/2012)
6.68 - Resolution - Adoption of the 1,000 Hour... (08/2011)
6.71 - Certificate of Sheriff's Law Enforcement Service (09/2007)
6.72 - Resolution - To Include Compensation Paid Under an IRC Section 125 Plan as IMRF Earnings (8/2003)
6.73 - Resolution - To Include Compensation Paid Under a Retirement Health Savings Plan as IMRF Earnings (4/2003)
6.74 - Resolution - To Include Taxable Allowances as IMRF Earnings(12/2011)
6.77 - Resolution - To Adopt Early Retirement Incentive... (Rev. 08/2014)
6.78 - Resolution - To Adopt Amortization Period for IMRF ERI (07/2003)
6.82 - Suggested Form of Resolution to Revoke Alternative Benefit Program for County Officers (3/2002)
6.85 - Resolution - For Employer Pick Up of Member Contributions... (12/2005)
6.88 - Suggested Form of Resolution to designate the regional office of education as an IMRF reporting entity distinct from the county (10/2008)
6.92 - IMRF Transfer to State Employees Retirement System (SERS Alternative Retirement Formula Plan) Under Public Act 95-0530 (08/2007)
6.94 - Elected County Official Stipend Purchase Under Public Act 96-0961 (HB 4644) (07/2010)
6.95 - Article 3 Police Pension Fund Transfer to IMRF Under Public Act 97-0273 (08/2011)

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Form Series No. #7

7.10 - Health Insurance Continuation Through Employer—Premium Deduction Authorization (08/2013)
7.12D - Election For Deductions for Health or Long Term Care Insurance Premiums Paid Directly to Insurer (Rev. 11/2013)
7.12E - Election For Deductions Health or Long Term Care Premiums Paid through Employer or Endorsed Plan Administrator (Rev. 11/2013)

 


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IMRF Online provides a brief summary of IMRF benefits and the adminstration of those benefits. IMRF members' and employers' rights and obligations are governed by Article 7 of the Illinois Pension Code. Statements in these publications are general, and the Illinois state law governing IMRF is complex and specific. If a conflict arises between information in these publications and the law, all decisions are based on the law.

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Page Last Updated by sia on 08/13/2014
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