Member Forms

If you know a form number, you may have an easier time locating the form by using our forms by number page.

All IMRF forms available online are in a Portable Document Format (PDF) and require Adobe Acrobat Reader Software to view and print. To download a free copy of the Adobe software click here. If you have problems viewing any of these documents, we recommend that you make sure you are using the latest version of the Adobe Acrobat Reader Software.

Forms index by subject or life event

• Requesting a refund of your IMRF member contributions?
• Paying back a refund?
• Changing your address (or other member information)?
• Retiring?
• Death related...
• Unable to work due to sickness or injury?
• Divorcing?
• Marriage, birth or death of a child; or death of a spouse
• Maximized your pension (contributed to IMRF for 40 years)?
• Electing to drop out of the ECO plan?
• Taking an unpaid leave of absence from work?
• Purchasing service credit? (ERI, military, etc.)
• Paying for service you wish to purchase/convert
• Want to make voluntary additional contributions to IMRF?

Requesting a refund (or rollover) of your IMRF member contributions?

• Application for Separation Refund, Form 5.10
• Previously Taxed Rollover Request, Form 5.10B

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Paying back a refund?

• Application for Reinstatement of Service Credit, Form 6.03
• To repay the refund with money from an IRA, a Section 457 plan, Section 403(b) plan, or other eligible plan: Rollover Certification for Payment of Past Service, Form 6.01
• To to repay the refund through payroll deduction: Tax-Deferred Payroll Deduction Program Application, Form 6.08A

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Changing your address?

• Member Information Change, Form 6.20

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Retiring?

• Use the Retirement Checklist to make sure you don't miss any step of your retirement process
• Pension Estimate Request, BF-20
• Application for Retirement Annuity, Form 5.20
• If you would like to have your pension payments “revert” (become payable) to someone else upon your death: Reversionary Annuity (Pension) Application, Form 5.20R (Learn more about reversionary annuities.)
• Direct Deposit Authorization Form, Form 1199
• If you are retiring under ERI: Member's Notice of Intent to Retire under ERI, Form 5.21
• If you will continue your employer’s health insurance plan and want premiums deducted from your pension payments: Health Insurance Premium Deduction Authorization, Form 7.10
• If you plan to enroll in an IMRF-endorsed health insurance plan and want premiums deducted from your pension payments: Health Care Program Premium Deduction Authorization, Form 7.10E
• If you will receive a refund of your surviving spouse, SLEP, or ECO member contributions: Distribution/Rollover Certification, Form BW-60

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Death related...

• Application for Death Benefit, Form 5.30
• Designation of Beneficiary, Form 6.11

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Unable to work due to sickness or injury?

• Member Application for Disability Benefit, Form 5.40
• Physician's Statement-Disability Claim, Form 5.42
  (Use Form 5.42 for new disability claims only. Contact IMRF for the appropriate form If you need to submit medical evidence of a continuing disabling condition.)
• Your employer needs to complete: Employer Statement--Disability Claim, Form 5.41

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Divorcing?

• QILDRO (Qualified Illinois Domestic Relations Order) Form
• QILDRO Consent Form
• QILDRO Court Calulation Order Form
• Member Information Change, (if your name or address changed) Form 6.20
• Designation of Beneficiary, Form 6.11

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Marriage, birth, or death of a spouse or child

• Designation of Beneficiary, Form 6.11

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Maximized your pension (contributed to IMRF for 40 years)?

• 40-year Service Election to Cease Contributions, Form 6.24

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Electing to drop out of the ECO plan?

• Revocation of Election to Participate in Elected County Official (ECO) Plan, Form 6.28

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Taking an unpaid leave of absence from work?

IMRF Benefit Protection Leave, Form 6.32

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Purchasing service credit? (ERI, military, etc.)

The application you submit is based on the type of service you wish to purchase/convert. Also see “Paying for service credit you wish to purchase/convert”

• Reinstating IMRF service credit you forfeited by accepting a refund: Application for Reinstatement of Service Credit, Form 6.03
• Converting time spent in the military to IMRF service credit: Application for Military Service Credit, Form 6.02J
• Taking an unpaid leave of absence from work and want to continue your IMRF benefits, IMRF Benefit Protection Leave, Form 6.32
• You worked in an IMRF-covered position but your employer did not report you to IMRF, Omitted Service Credit Verification, Form 6.05
• Purchasing service you earned with your employer before it joined IMRF: Application for Prior Service Credit, Form 6.07
• Transfering service credit with an out-of-state public pension system to IMRF: Out-of-State Service Credit Authorization, Form 6.33
• Converting existing Regular IMRF or SLEP service to ECO service: Conversion of Regular or SLEP Service Credit to ECO Service Credit, Form 6.06
• Estimating how much Regular IMRF or SLEP service to convert to ECO to earn the maximum ECO pension: ECO Conversion Analysis/Estimate Request, Form 6.38
• Illinois General Assembly member who previously served as an elected official for an IMRF employer and did not elect to participate in IMRF at that time: Application by a Member of the General Assembly for Service Credit as an Elected Official, Form 6.34
• Employees who previously barred from IMRF participation because of their age: Application for Retroactive Service Credit for Employees Previously Barred by Age, Form 6.04A
• Elected officials and city hospital employees who worked in an IMRF-covered position before they elected to participate in IMRF; retirees over age 60 who returned to work in an IMRF-covered position before to January 1, 1970 and had to wait one year before being enrolled; members who worked in an IMRF-covered position between January 1, 1956, and July 1, 1957, and had to wait one year before being enrolled, employees of township road districts that became participating IMRF employers on June 1, 1974, as part of a township; ROTC instructors who worked in an IMRF-covered position before to October 1, 1977: Application for Retroactive Service Credit, Form 6.04

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Paying for service you wish to purchase/convert

• To purchase the service credit with money from an IRA, a Section 457 plan, Section 403(b) plan, or other eligible plan: Rollover Certification for Payment of Past Service, Form 6.01

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Want to make voluntary additional contributions to IMRF

• IMRF members have the option of making after-tax voluntary additional contributions to provide a retirement pension in addition to the usual retirement pension based on usual contributions. These after-tax voluntary additional contributions are limited to 10% of your gross earnings and are not matched by your employer. The additional retirement pension is based solely upon the accumulated voluntary contributions plus interest (currently 7.50%).
• To participate in IMRF's Voluntary Additional Contribution Program: Election to Make Voluntary Additional Contributions, Form 6.30

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