Pension Forms

For information about which forms to use, review Member Benefits.

Contact us with any questions.

Forms and Information

• Act 125 Summary(PDF, 189KB) – Notification for employees hired after February 21, 2014
• Allegheny County Retirees Association (ACRA) Enrollment Form(PDF, 627KB) – Use for initial enrollment and to pay yearly dues
• Application for Membership(PDF, 860KB) – Completed during new employee orientation
• Application for Retirement(PDF, 316KB) – Monthly pension benefit election
• Beneficiary Forms:
  • Contribution(PDF, 326KB)
  • Life Insurance(PDF, 593KB)
  • Life Insurance Extra Coverage Election(PDF, 149KB)
  • Spousal Acknowledgement(PDF, 307KB)
  • Survivorship(PDF, 344KB)
• Change of Name or Address(PDF, 283KB)
• Direct Deposit Form(PDF, 319KB)
• Federal W-4P(PDF, 105KB) – For use if your tax information has changed
• Health Benefit Cancellation Form(PDF, 12KB)
• Military Service Credit:
  • For Active Duty Military(PDF, 3MB)
  • For Military Service Prior to Employment(PDF, 2MB)
• Pension Benefit Estimate Form(PDF, 251KB)
• Previous Contribution Withdrawal Repayment(PDF, 313KB)
• Qualified Domestic Relations Order (Sample)(PDF, 30KB) :
  • Guidelines for Domestic Relations Order(PDF, 136KB)
• Re-Employed Members – Act 125 Notices:
  • Act 125 Acknowledgement Form(PDF, 189KB)
  • Deferred Vested Re-Employment(PDF, 84KB)
  • Non-vested Re-Employment(PDF, 81KB)
  • Re-Hired Retired Employment(PDF, 85KB)
• Retirement Pension Check Calendar(PDF, 138KB)
• Right to Know:
  • Right to Know Policy(PDF, 201KB)
  • Right to Know Request Form
• Six-Month Waiver Repayment(PDF, 321KB)
• Workers' Compensation Deduction(PDF, 336KB) – Authorization for retirement contribution deduction