| Federal forms |
| 10-W4 |
Withholding Certificate for Periodic Pension or Annuity Payments (for retirement benefits) |
IRS form |
| 05-W4P |
Withholding Certificate for Periodic Pension or Annuity Payments (for DROP/ILSB withdrawals) |
IRS form |
| 05-W4R |
Withholding Certificate for Nonperiodic Payments and Eligible Rollover Distributions (for DROP/ILSB withdrawals) |
IRS form |
| 10-W4R |
Withholding Certificate for Nonperiodic Payments and Eligible Rollover Distributions (for refund payments) |
IRS form |
| |
| TRSL forms |
| 1 |
Authorized Contacts (01/22) |
| 1EDC |
Employer Directory Contacts (07/21) |
| 2 |
Enrollment Application/Employment Notification (03/22) |
| 2AC |
Change of Address Authorization (02/21) - For active members, retirees, beneficiaries, & alternate payees |
| 2C |
Certification of Membership in State System (02/21) |
| 2FRB |
Forfeiture of Retirement Benefits - Attestation of Understanding (02/21) |
| 2NC |
Active Member Name Change Request (02/22) |
| 2PT |
Enrollment Application for Secondary Part-Time Position with Same Employer (02/21) |
| 2R |
Election to Retain Membership (03/22) |
| 2SS |
Statement Concerning Your Employment in a Job Not Covered by Social Security (02/21) |
| 3 |
Beneficiary Designation for Non-Retired Members (12/20) - Return-to-work retirees use 3C |
| 3A |
Change of Beneficiary for Option 1 Retiree (12/20) |
| 3B |
Beneficiary Designation for DROP and ILSB Accounts (12/20) |
| 3C |
Beneficiary Designation for Retiree Return-to-Work Employee Contributions (12/20) |
| 4C |
Employment Terminations (05/21) |
| 4D |
Payment Distribution Voucher (05/21) |
| 4F |
Prior Year Correction of Earnings and Contributions (05/21) |
| 7 |
Application for Refund (12/22) (See "Special Tax Notice Regarding TRSL Payments") |
| 7A |
Retiree Refund Application (07/21) (See "Special Tax Notice Regarding TRSL Payments") |
| 7D |
Direct Deposit for Refund of Contributions (04/21) (See "Special Tax Notice Regarding TRSL Payments") |
| 8 |
Application for Reciprocal Recognition of Service (05/21) |
| 8A |
Application for Transfer of Creditable Service (05/21) |
| 8BR |
Application for Purchase of Refunded Service to Reciprocate (05/21) |
| 8BT |
Application for Purchase of Refunded Service to Transfer (05/21) |
| 9 |
Application for Purchase of In-state Service (02/22) |
| 9A |
Application for Purchase of Out-of-State Public School Employment (02/22) |
| 9B |
Application for Purchase of Military Service (07/21) |
| 9C |
Application for Purchase of U.S. Dependent School Teaching Service (02/22) |
| 9D |
Application for Purchase of Refunded Service (07/21) |
| 9E |
Application for Purchase of In-state Private / Charter School Service (07/21) |
| 9R |
Rollover/Trustee-to-Trustee Transfer Acceptance (05/21) |
| 10 |
Benefit Estimate Request (07/21) |
| 11 |
Application for Service Retirement, ILSB, or DROP (12/22) - Replaces old forms 11A and 11F |
| 11B |
Agency Certification (7/22) |
| 11G |
DROP or ILSB Account Spousal Consent (11/20) |
| 11G-1 |
DROP or ILSB Retiree Spousal Consent to Withdrawal Method (11/20) |
| 11H |
Termination of Employment at End of DROP Participation/Employment (12/22) |
| 11J |
DROP or ILSB Retiree Withdrawal Method Selection (12/22) |
| 11K |
DROP or ILSB Retiree Nonspousal Beneficiary Request for Withdrawal Selection (12/22) |
| 11K-E |
DROP or ILSB Retiree or Beneficiary's Estate or Successor's Request for Withdrawal (12/22) |
| 11K-P |
DROP or ILSB Retiree Alternate Payee Receiving Split Benefit as a Result of Divorce (12/22) |
| 11K-S |
DROP or ILSB Retiree Spousal Beneficiary Request for Withdrawal Selection (12/22) |
| 11M-S |
DROP or ILSB Retiree Spousal Beneficiary Request for Withdrawal (12/22) |
| 11N |
DROP or ILSB Retiree Withdrawal Method Selection for Ages 73 and Over (12/22) |
| 11PS |
DROP or ILSB Retiree Partial Single-Sum Withdrawal (12/22) |
| 11R |
Direct Deposit of DROP or ILSB Account Withdrawals (04/22) - Use 15D for regular benefits |
| 11RTW |
Application for Return-to-Work (RTW) Supplement (12/22) |
| 11S |
Sick Leave Certification (11/20) |
| 12 |
Application for Disability Retirement (01/21) - now combined with Form 12B |
| 12A |
Disability Report by Supervisor (01/21) |
| 12B |
Member Statement of Disabling Condition - now combined with Form 12 |
| 12C |
Physician Report of Disabling Condition (01/21) - now combined with Form 12C-P |
| 12C-P |
Physician Report of Disabling Condition - now combined with Form 12C |
| 12D |
Physician Annual Report of Disabling Condition (07/21) - For retirees only |
| 12PDMC |
Statement of Child's Permanent Disabling Condition (01/21) |
| 13 |
Application for Survivor Benefits (04/21) |
| 13A |
Application for Refund of Deceased Member's Contributions (12/22) |
| 13C |
Student Attendance Certification (07/21) |
| 13E |
Application for Payment to Surviving Spouse/Children (04/21) |
| 13M |
Statement of Dependent's Marital Status (04/21) |
| 14A |
Company Application Retiree Payroll Deduction Program (12/21) |
| 15 |
Retiree Return-to-Work Notification (obsolete) refer to Procedures Manual for enrollment instructions, Index 15.0 |
| 15C |
Retiree Change of Address Authorization - OBSOLETE (Use Form 2AC) |
| 15CS |
Retiree Return-to-Work Critical Shortage Certification (06/22) |
| 15D |
Direct Deposit of Benefits (04/22) - Use 11R for DROP or ILSB account withdrawals |
| 15ELEC |
Return-to-Work (RTW) of TRSL Retiree - La. R.S. 11:710.1 (06/22) |
| 15JS |
Addendum to Direct Deposit of Benefits - Nonspousal Joint Signer(s) (12/20) |
| 15PA |
Affidavit for Power of Attorney and Agent's Affidavit for Acceptance (1/23) |
| 15TR |
RTW of TRSL Retiree - Special Transfer Group Election of 2010 Group Coverage (07/22) |
| 16 |
Application for ORP or Change of Carrier (10/22) |
| 16AC |
ORP Member Change of Address Authorization (07/21) |
| 16NC |
ORP Member Name Change Request (07/21) |
| 18 |
Electronic Reporting Registration (07/21) |
| FBR |
Option to Continue Contributions during Time of Furlough without Pay (07/21) |
| PARC |
Petition for TRSL Administrative Rule Adoption, Amendment, or Repeal (07/21) |
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Beneficiary/Survivor Checklist