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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