Forms for Retirees and Annuitants

for IMRF Customers
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IMRF encourages you to use secure access for these transactions whenever possible. It's faster, easier and more secure. PDF forms may be downloaded and filled in on your computer to enhance legibility.

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Establish or change tax withholding from benefit payments - Use the 2021 W-4P for 2022 Member Access Form W4P
Make changes to your name, address, phone or other information Member Access Form 6.20R
Apply for a death benefit NA Form 5.30
Apply to serve as a representative payee for an annuitant NA Form 5.60
Apply to serve as a representative payee for an annuitant by a nursing home or hospital NA Form 5.63
Name or change the beneficiary of your annuitant death benefit Member Access Form 6.11A
Establish or change direct deposit of payments Member Access Form 1199
Authorize IMRF to deduct insurance premiums from your benefit payment to your former employer for health insurance NA Form 7.10
Elect to have deductions for health or long-term care insurance premiums paid directly to the insurer for a retired public safety officer. NA Form 7.12D 
Instruct IMRF to pay insurance premiums from your pension directly to your former employer for health or long-term care premiums for a retired public safety officer.
NA  Form 7.12E
Prepare a Qualified Illinois Domestic Relations Order (QILDRO) for filing in court in the event of divorce NA Form QILDRO
Request to remove name and address from blind mailings NA Blind Mailings Removal Request Form