Forms

FOR ACTIVE MEMBERS - Information & forms for members who are currently working for PERA affiliated employers or that have contributions on account with PERA

  • Application for Membership (Posted 12/04/2012) - To be used by a new employee enrolling with PERA for the first time or by an existing member when beginning work with a new affiliated employer.
  • Beneficiary Designation (posted 4/11/2013) - To be used by an active member to designate a survivor and refund beneficiary to receive a death benefit after the death of the member. This is a new form that combines both beneficiary designations.
  • Change in PERA Records (Posted 12/04/2012) - To be used by all active members to notify PERA of a change of address, a change of name or a change of social security number.
  • PERA Request Form (Updated 3/27/2013) - To be used by an active member who wishes to request an estimate of benefits (must be within 3 years of retirement); cost calculations for air time, with drawn service, or military service; prepare a service credit verification or request a PERA Retirement Kit.
  • PERA Early Out Request Form (Posted 12/04/2012) - To be used by an active member employed by Bernalillo County, the City of Albuquerque, the City of Rio Rancho or the City of Santa Fe who are using these employer's early out programs and are requesting an estimate of benefits, cost calculations for air time, withdrawn service, or military service.
  • Affidavit for Free Military Service (Posted 12/04/2012) - To be used by a members called to active military service while actively employed by a PERA affiliated-employer to certify the dates of employment and military service.
  • Termination Notice (Posted 12/10/2012) - To be used by members who are terminating their position and wish to withdraw their PERA contributions. The member's last PERA affiliated public employer must certify this form if it has been less than one year since the termination date. If it has been longer than one year, the last employer does not need to complete the top portion of the form. Requests for cash refunds may now be direct deposited. The direct deposit form MUST accompany the PERA Termination Notice if a direct deposit is requested.
  • Important Information for Refunding Members (Posted 4/18/2013)
  • State Transfer Form (Posted 12/04/2012) - To be used by members who are employed by the State of New Mexico and are transferring to a new job between state agencies.
  • 1099R Instructions for Recipient - Instructions for people who have received a refund of their PERA employee contributions or are receiving a monthly pension benefit. (Posted 7/1/2010)

FOR STATE LEGISLATOR MEMBER COVERAGE PLAN 2 - Information & forms for members who are currently elected as a state legislator or lieutenant governor.

FOR RETIRING MEMBERS - Information & forms for members who are preparing to retire from a PERA affiliated employer

FOR EMPLOYERS - Information & forms for PERA affiliated employers

  • Contribution Remittance (Posted 6/11/2009) - To be used by employers submitting payment of PERA employee and employer contributions.
  • Termination Notice (Posted 6/03/2011) -To be used by members who are terminating their position and wish to withdraw their PERA contributions. The member's last PERA affiliated public employer must certify this form if it has been less than one year since the termination date. If it has been longer than one year, the last employer does not need to complete the top portion of the form. Requests for cash refunds may now be direct deposited. The direct deposit form MUST accompany the PERA Termination Notice if a direct deposit is requested.
  • Employer Certification for Retiring Employees - To be used by employers to certify to PERA the last day of employment and the last month of earned salary.
  • Employer Certification for Free Military Service (Posted 6/1/2011) - To be used by the employer to certify the dates of employment prior to and immediately after activation into military service.

LEGAL FORMS

  • Model Order Dividing Retirement Benefits (Posted 10/18/2011) - To be used by an active or retired member to divide the community interest in PERA retirement benefits and to directly pay an ex-spouse his or her share of benefits.

EXCLUSIONS - Information & forms for employees of a PERA affiliated-employer who are requesting exclusion from PERA membership

VOLUNTEER FIREFIGHTERS - Information & forms for volunteer firefighters

  • Volunteer Firefighter Enrollment Form (Posted 7/1/2010) - To be used by people enrolling in the volunteer firefighter program.
  • Volunteer Firefighters Service Credit Qualification Record (Posted 2/9/2010) - To be used by the department chief to report service credit for the entire department. This form must be received by PERA by March 31 of each year to ensure credit is given for the individuals in the department.
  • Volunteer Firefighters Annual Reporting (Posted 6/11/2009) - To be used by the department chief to certify the number of meeting, drills and responses the department had for the year.
  • Adjusted Qualification Record (Posted 7/5/2009) - To be used by an individual Firefighter to adjust/correct service credit for prior years which their department reported incorrectly or failed to report. This form must be submitted with the "Adjusted Qualification Report".
  • Adjusted Qualification Report (Posted 7/5/2009) - This form is to be signed by the member in front of a notary public certifying the information on the "Adjusted Qualification Record" is true and correct. This form must also be signed by the mayor or chair of the county commission.
  • Firefighters Information Brochure (Updated 10/6/2009)