| Federal forms |
| W-4P |
Withholding Certificate for Pension or Annuity Payments |
IRS form |
| |
| TRSL forms |
| 1 |
Authorized Contacts (04/18) |
| 1EDC |
Employer Directory Contacts (04/18) |
| 2 |
Enrollment Application/Employment Notification (02/15) |
| 2AC |
Active Member Change of Address Authorization (04/17) |
| 2C |
Certification of Membership in State System (03/15) |
| 2FRB |
Forfeiture of Retirement Benefits - Attestation of Understanding (1/13) |
| 2NC |
Active Member Name Change Request (08/14) |
| 2PT |
Enrollment Application for Secondary Part-Time Position with Same Employer (04/18) |
| 2R |
Election to Retain Membership (06/18) |
| 2SS |
Statement Concerning Your Employment in a Job Not Covered by Social Security (10/14) |
| 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 (04/05) |
| 4D |
Payment Distribution Voucher (01/20) |
| 4F |
Prior Year Correction of Earnings and Contributions (08/07) |
| 6A |
Certification of Supplemental Credit (02/04) |
| 7 |
Application for Refund (10/17) (Please see "Special Tax Notice Regarding TRSL Payments") |
| 7A |
Retiree Refund Application (01/19) (Please see "Special Tax Notice Regarding TRSL Payments") |
| 7D |
Direct Deposit for Refund of Contributions (12/11) (Please see "Special Tax Notice Regarding TRSL Payments") |
| 7L |
Taxable Lump-Sum Distribution Election (02/02) (Please see "Special Tax Notice Regarding TRSL Payments") |
| 8 |
Application for Reciprocal Recognition of Service (08/07) |
| 8A |
Application for Transfer of Creditable Service (01/21) |
| 8BR |
Application for Purchase of Refunded Service to Reciprocate (08/07) |
| 8BT |
Application for Purchase of Refunded Service to Transfer (08/07) |
| 9 |
Application for Purchase of In-state Service (1/19) |
| 9A |
Application for Purchase of Out-of-State Public School Employment (1/19) |
| 9B |
Application for Purchase of Military Service (1/19) |
| 9C |
Application for Purchase of U.S. Dependent School Teaching Service (1/19) |
| 9D |
Application for Purchase of Refunded Service (08/02) |
| 9E |
Application for Purchase of In-state Private / Charter School Service (1/19) |
| 9R |
Rollover/Trustee-to-Trustee Transfer Acceptance (04/14) |
| 10 |
Benefit Estimate Request (05/19) |
| 11 |
Application for Service Retirement, ILSB, or DROP (01/21) - Replaces old forms 11A and 11F |
| 11B |
Agency Certification (12/20) |
| 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 (11/20) |
| 11J |
DROP or ILSB Retiree Withdrawal Method Selection (11/20) |
| 11K |
DROP or ILSB Retiree Nonspousal Beneficiary Request for Withdrawal Selection (11/20) |
| 11K-P |
DROP or ILSB Retiree Alternate Payee Receiving Split Benefit as a Result of Divorce (11/20) |
| 11K-S |
DROP or ILSB Retiree Spousal Beneficiary Request for Withdrawal Selection (11/20) |
| 11M-S |
DROP or ILSB Retiree Spousal Beneficiary Request for Withdrawal (11/20) |
| 11N |
DROP or ILSB Retiree Withdrawal Method Selection for Ages 72 and Over (11/20) |
| 11PS |
DROP or ILSB Retiree Partial Single-Sum Withdrawal (11/20) |
| 11R |
Direct Deposit of DROP or ILSB Account Withdrawals (11/20) - Use 15D for regular benefits |
| 11RTW |
Application for Return-to-Work (RTW) Supplement (11/20) |
| 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 (01/21) - For retirees only |
| 12PDMC |
Statement of Child's Permanent Disabling Condition (01/21) |
| 13 |
Application for Survivor Benefits (05/10) |
| 13A |
Application by Nonspousal Beneficiary for Refund of Deceased Member's Contributions/Benefits (12/14) |
| 13AS |
Application by Spouse for Refund of Deceased Member's Contributions/Benefits (12/14) |
| 13C |
Student Attendance Certification (04/14) |
| 13E |
Application for Payment to Surviving Spouse/Children (12/14) |
| 13M |
Statement of Dependent's Marital Status (12/06) |
| 14A |
Company Application Retiree Payroll Deduction Program (04/18) |
| 15 |
Retiree Return-to-Work Notification (obsolete) refer to Procedures Manual for enrollment instructions, Index 15.0 |
| 15C |
Retiree Change of Address Authorization (12/20) - Also for survivors, beneficiaries, and alternate payees |
| 15CS |
Retiree Return-to-Work Critical Shortage Certification (12/20) |
| 15D |
Direct Deposit of Benefits (12/20) - Use 11R for DROP or ILSB account withdrawals |
| 15ELEC |
Return-to-Work (RTW) of TRSL Retiree - La. R.S. 11:710.1 (12/20) |
| 15JS |
Addendum to Direct Deposit of Benefits - Nonspousal Joint Signer(s) (12/20) |
| 15PA |
Affidavit for Power of Attorney (12/20) |
| 16 |
Application for ORP or Change of Carrier (06/19) |
| 16AC |
ORP Member Change of Address Authorization (09/10) |
| 16NC |
ORP Member Name Change Request (09/10) |
| 18 |
Electronic Reporting Registration (07/10) |
| FBR |
Option to Continue Contributions during Time of Furlough without Pay (10/09) |
| PARC |
Petition for TRSL Administrative Rule Adoption, Amendment, or Repeal (07/19) |
Beneficiary/Survivor Checklist