PSRS Release of Information Authorization Form 2025

1. Click ‘Get Form’ to open the PSRS Release of Information Authorization Form in the editor.
2. In SECTION A, fill in your personal information including your first name, middle name, last name, member ID (or last four digits of your Social Security Number), telephone number, mailing address, city, state, ZIP code, and email address.
3. Move to SECTION B. Here, you will authorize individuals or organizations to receive your information. Fill in their names, phone numbers (primary and work), email addresses, organization (if applicable), relationship to you, and any special instructions.
4. Specify the start and end dates for this authorization in SECTION B. Remember that this release is valid for a maximum of 24 months.
5. In SECTION C, read the authorization statement carefully. You must provide your original signature and date it to finalize the form.
6. Once completed, save your document and return it to PSRS/PEERS via mail or fax as indicated on the form.

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