ORBIT - Available Forms: (2024)

Form no.Form Description

Form11S

11S-Monthly Remittance of Fees for the Registers of Deeds' Supplemental Pension Fund

Form170

170-Authorizing Direct Deposit

Form170S

170S-Survivor's Benefit: Authorizing Direct Deposit

Form170TB

170TB-Authorizing Direct Deposit for the Transfer Benefit

Form237

237-Reporting Your 2023 Income To Continue Your Retirement System Disability Benefit

Form253

253-Reporting an Employee's Work Record In the Event of Death

Form276

276-Designating Beneficiary(ies) for the Separate Insurance Benefit Plan for Law Enforcement

Form290

290-Choosing Income Tax Withholding Preferences - (Update Online in ORBIT)

Form290401K

290401K-Choosing 401K Income Tax Withholding Preferences

Form290457

290457-Choosing 457 Income Tax Withholding Preferences

Form290S

290S-Survivor's Benefit: Choosing Income Tax Withholding Preferences

Form296

296-Reporting Your 2023 Income To Continue Your Benefit Through the Disability Income Plan

Form297

297-Reporting Your 2023 Income to Continue Your Disability Salary Continuation Plan Benefit

Form2C

2C-Designating Beneficiary(ies) - (Update Online in ORBIT)

Form2FR

2FR-Designating Beneficiary(ies) for the Firefighters' and Rescue Squad Workers' Pension Fund

Form3

3-Declining to Participate in the Local Governmental Employees' Retirement System

Form316

316-Pink Sheet Refund

Form319401K

319401K-Choosing to Transfer NC401(k) Plan Contributions for an Additional Monthly Benefit

Form319457

319457-Choosing to Transfer NC Deferred Compensation (457) Plan Contribs for an Additional Monthly Benefit

Form319LEO

319LEO-Choosing to Transfer NC401(k) Plan Contributions for an Additional Monthly Benefit for LEOs

Form333BEN

333BEN-Designating Beneficiary(ies) for the Contributory Death Benefit for Retired Members

Form333SAMPLE

333SAMPLE-Choosing the Contributory Death Benefit for Retired Members

Form336

336-Designating Beneficiary(ies) for the Guaranteed Refund as a Retiree

Form336401K

336401K-Designating Beneficiary(ies) for the 401K Guaranteed Refund

Form336457

336457-Designating Beneficiary(ies) for the 457 Guaranteed Refund

Form348

348-Requesting Leave of Absence in the Firemen's and Rescue Squad Workers' Pension Fund

Form349

349-Purchasing Pension Fund Credit for Prior Fire or Rescue Service

Form350

350-Enrolling in the Firefighters' and Rescue Squad Workers' Pension Fund

Form359

359-Transferring Accounts in the Firefighters' and Rescue Squad Workers' Pension Fund

Form398

398-Using A Distribution of Tax-Sheltered Savings to Purchase Retirement Credit

Form4

4-Certification of Local Government Service

Form430

430-Purchasing Retirement Credit for a Period of Interrupted Service Related to Parental Leave

Form441

441-Purchasing Retirement Credit for a Period of Workers’ Compensation

Form443

443-Purchasing Retirement Credit for State or Local Government Temporary Employment

Form451

451-Purchasing Retirement Credit for a Period of Part-Time State or Local Government Employment

Form452

452-Purchasing Retirement Credit for a Period of Service with a Non-Participating Local Unit

Form455

455-Purchasing Retirement Credit for a Period of Out-of-State Employment

Form461

461-Purchasing Retirement System Credit for Withdrawn Service

Form462

462-Purchasing Retirement System Credit for Military Service

Form463

463-Purchasing Retirement Credit for a Period of Interrupted Service for Educational Purposes

Form463F

463F-Requesting Continuation of Contributions and Credit for Planned Educational Leave

Form466

466-Purchasing Retirement System Credit for Unreported Service Omitted Through Error

Form467

467-Purchasing Retirement System Credit for a Period of Federal Service

Form470

470-Purchasing Retirement Credit for a Waiting Period Imposed by a Local Unit

Form478

478-Purchasing Retirement System Credit for Withdrawn Optional Retirement Program Service

Form485

485-Purchasing Retirement Credit for a Period of Interrupted Service Due to Extended Illness

Form499

499-Purchasing Retirement Credit for a Period of Service with a Non-Participating Charter School

Form5

5-Withdrawing Your Retirement Service Credit and Contributions

Form5COA

5COA-Address change verification for Refunds

Form5FR

5FR-Withdrawing Contributions from the Firefighters' and Rescue Squad Workers' Pension Fund

Form5TR

5TR-Transferring Service and Contributions Between Systems

Form6

6-Claiming Your Retirement Benefit

Form641

641-Public School Unit Certification

Form6C

6C-Reporting an Employee's Work Record for Retirement

Form6ERSAMPLE

6ERSAMPLE-Authorizing Your New Spouse As Beneficiary

Form6ESAMPLE

6ESAMPLE-Sample 6E Choosing Your Retirement Payment Option

Form6FR

6FR-Retiring from the Firefighters' and Rescue Squad Workers' Pension Fund

Form6SABSAMPLE

6SABSAMPLE-Choosing the Survivor's Alternate Benefit

Form7

7-Requesting Disability Retirement Benefits

Form700

700-Required Employer Information

Form701

701-Requesting the Short-Term of Benefits through the Disability Income Plan of North Carolina

Form703

703-Medical Report for Eligibility Review of Short-Term Disability Benefits

Form704

704-Requesting Additional Benefits through the Disability Income Plan of North Carolina

Form705

705-Agreeing to Accept Long-Term Benefits through the Disability Income Plan of N.C.

Form706

706-Confirming an Employee's Resignation

Form707

707-Reporting Earnings Monthly While Receiving Extended Short-Term or Long-Term Benefits

Form710

710-Employer's Worksheet for Determining the Waiting Period Before the Short Term Begins

Form711

711-Determining the Maximum Monthly Benefit During the Short Term

Form712

712-(Optional) Determining the Affect of Other Benefits on the Short-Term Benefit

Form713

713-(Optional) Determining the Short-Term Benefit for Partial and Special Months

Form717

717-Employer Bank Change Request Form

Form7A

7A-Medical Report for Disability Eligibility Review

Form7AR

7AR-Medical Report for Re-exam

Form7E

7E-Choosing Your Disability Retirement Payment Option

Form7FR

7FR-Requesting Disability Status from the Firefighters' and Rescue Squad Workers' Pension Fund

FormACCTMIDAFF

ACCTMIDAFF-Affidavit of Identity

FormCOA

COA-Updating Your Addresses or Name

FormDB228

DB228-Choosing Tax Treatment for a Payment of Undistributed Contributions Due to a Death

FormERRWK

ERRWK-Correcting an Employee's Payroll Record

FormESRR

ESRR-Certifying Employee Status Under Retirement Reemployment Laws

FormHMONLINE

HMONLINE-Instructions for Changing Retiree Health Coverage Through the State Health Plan Online

FormMR

MR-Authorizing the Release of Medical Records

FormORP

ORP-Certifying Optional Retirement Program (ORP) Service Credit Under TSERS Reciprocity Provisions

FormSUP

SUP-The Supplemental Retirement Plans

FormSVC

SVC-Reviewing Your Service Record and Requesting an Audit of Your Service Credit
ORBIT - Available Forms: (2024)
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