Pension Forms

• 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, 335KB) - Monthly pension benefit election
• Beneficiaries - Contribution(PDF, 786KB)
• Beneficiaries - Life Insurance(PDF, 593KB)
• Beneficiaries - Life Insurance Extra Coverage Election(PDF, 155KB)
• Beneficiaries - Spousal Acknowledgement(PDF, 307KB)
• Beneficiaries - Survivorship(PDF, 945KB)
• Change of Name or Address(PDF, 283KB)
• Direct Deposit Form(PDF, 1MB)
• Federal W-4P - For use if tax information has changed
• Military - Active Duty(PDF, 3MB)
• 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-Employment - Act 125 Acknowledgement Form(PDF, 189KB)
• Re-Employment - Deferred Vested(PDF, 84KB)
• Re-Employment - Non-Vested(PDF, 81KB)
• Re-Employment - Retiree(PDF, 85KB)
• 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

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