Skip to main navigation
Skip to main content
Ky.
gov
An Official Website of the Commonwealth of Kentucky
Menu
Login
Members
Members
Members Overview
Tier 1
Benefit Calculation
Retirement Eligibility
Purchasing Credit and Service Types
Sick Leave
Refund of Contributions
Tier 2
Benefit Calculation
Retirement Eligibility
Tier 3 Opt-In
Purchasing Credit and Service Types
Sick Leave Credit
Refund of Contributions
Tier 3
Cash Balance Plan
Benefit Calculation
Retirement Eligibility
Purchasing Credit and Service Types
Refund of Contributions
Insurance
Insurance Overview
OE Non-Medicare - Plan Year 2025
OE Medicare - Plan Year 2025
Non-Medicare - Plan Year 2024
Medicare - Plan Year 2024
Qualifying Events
When you Retire
Who Is Covered?
Survivor Benefits
Line of Duty Death
Your Beneficiary
Disability Benefits
Eligibility Requirements
How to Apply
Ready to Retire
Ready to Retire
How to Apply
Service with Other Plans
Your Payment Options
After Retirement
Outreach and Programs
Outreach and Programs
Webinars and Videos
Managing Your Retirement Account
Retirees
Retirees Overview
Retirees Overview
Receiving Your Benefits
Taxes and Your Responsibilities
Marital Status and Beneficiary Change
Reemployment After Retirement
Survivor Benefits
Disability Benefits
Retiree Self Service
Retiree Outreach
Retiree Outreach
Videos
Webinars
Cost of Living Adjustments (COLAs)
Employers
Employers
Employers Overview
Contribution Rates
Reporting Officials
Home
File and Web
KHRIS
School Board
Creditable Compensation
Training
Home
Videos
Cessation
Reemployment
Contact Us
ERCE Teams & Management
Outreach Requests
Publications and Forms
Home
Employer Reporting Manual
Publications
Forms
Newsletters
Human Resources
GASB
GASB Overview
Prior Year
Resources
Investments
Investments
Investments Overview
Investments Library
Monthly Performance Reports
Investment Policies
Commissions Reports
Investment Holdings
Manager Fees
Internal Reports
Proxy Voting Reports
Investment Manager Contracts
Asset Class Reviews
Perimeter Park West (PPW)
Office of Investments Team
Investments Dictionary
Publications & Forms
Publications and Forms
Publications Overview
Forms
Retiree Forms
Disability Forms
Member Forms
Insurance Forms
Books and Guides
Annual Reports
Summary Annual Reports
Actuarial Valuations
Experience Studies
External and State Audits
Member Frequently Asked Questions
Member Pension Spiking Frequently Asked Questions
Member Newsletters
Government Officials Newsletters
News
About
About KPPA
Administration
Administration
Board Policies
Legal References
Administrative Hearings
Boards
Boards
KPPA
CERS
KRS
Meeting Calendar
Board Committees
Board Committees
AAC and DAC
Audit Committee
Retiree Health Plan Committee
CERS Investment Committee
KRS Investment Committee
CERS Finance Committee
CERS Actuarial Committee
KRS Actuarial Subcommittee
CERS Personnel Committee
KPPA Ad Hoc Regulation Committee
Old Investment Minutes
Submit Public Meeting Comments
Legislative Updates
Board Elections
KPPA-FYI
Former KRS Board
Legislative Updates
Contact
Contact KPPA
Careers at KPPA
Directions to KPPA
Open Records
Report Fraud
Current Solicitations
Paperless
Facebook
Twitter
YouTube
Publications Overview
Forms
Retiree Forms
Disability Forms
Member Forms
Insurance Forms
Books and Guides
Annual Reports
Summary Annual Reports
Actuarial Valuations
Experience Studies
External and State Audits
Member Frequently Asked Questions
Member Pension Spiking Frequently Asked Questions
Member Newsletters
Government Officials Newsletters
News
Member Forms
Form Disclaimer
All forms on the KPPA website can be viewed within any browser. If you would like to fill a form out online, you will need to use any browser
EXCEPT
Microsoft Edge.
Main Content
Member Forms
Download
Form 2001 - Membership Information
Form 2010 - Election or Rejection of Participation
Form 2022 - Separation of Accounts
Form 2035 - Beneficiary Designation
Form 2040 - Change of Contact Information
Form 4115 - Verification of Employment with the Federal Government
Form 4120 - Verification of Employment with a State University
Form 4131 - Verification of Urban-County Government Service
Form 4140 - Verification of Out of State Service
Form 4150 - Certification of Employment - Hazardous Position
Form 4170 - Direct Transfer/Rollover Authorization
Form 4172 - Notice of Intent to Transfer Lump-Sum Payment for Purchase of Service
Form 4225 - Verification of Past Employment
Form 4525 - Application for Refund and Direct Rollover of Member Contributions
Form 4527 - Certification by a "Qualified Public Safety Employee"
Form 6000 - Notification of Retirement
Form 6110 - Affidavit of Authorization to Receive Funds on Behalf of Minor
Form 6433 - Authorization for Release of Information and Request for Information
Form 6434 -Pre-Retirement QDRO for Division of Marital Property
Form 6439 - QDRO Alternate Payee Information
Form 6460 - Special Power of Attorney
Special Tax Notice for Application for Direct Rollover or Direct Payment
Relative Content
Connect With Us
Facebook
X
YouTube
LinkedIn