Pre-Application for Disability Retirement Benefits - PERS 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with the Member Information section. Fill in your first name, middle initial, last name, gender, social security number, birth date, email address, and mailing address. Ensure all details are accurate and complete.
3. In the Retirement Plan section, select the applicable retirement plan by checking the appropriate box. This is crucial for processing your application correctly.
4. Next, provide information about Potential Beneficiaries. List one person along with their social security number, birth date, and relationship to you. Remember that actual beneficiaries will be finalized later.
5. Complete the Applicant Authorization section by signing and dating the form. If someone else is signing on your behalf, attach proof of their authority.
6. Finally, ensure that an authorized representative from your employer completes the Employer Certification section with all required details before submitting.

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