Elected Official Questionnaire - Public Employees Retirement 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Name of PERA Affiliate and Mailing Address in the designated fields. Ensure all information is accurate and complete.
3. Fill in your City, State, Zip Code, and Date. These details are crucial for processing your questionnaire.
4. Provide your Payroll Officer's name and signature, along with their printed name and title.
5. In the ELECTED OFFICIAL INFORMATION section, enter your Social Security Number or PERA ID Number, First Name, Middle Initial, Last Name, and Address Type (Permanent or Temporary).
6. Complete the contact information fields including Home Telephone No., Business Telephone No., Email Address, City, State, and Zip Code.
7. Indicate your Elected Office and the Date Term Began. Answer the Yes/No questions regarding your elected status and salary payments carefully.
8. Finally, sign and date the form at the bottom to confirm that all provided information is true.

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