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Disability
04-01 | Disability Retirement Application (August, 2021) |
04-01C | Certification of Disability Sustained from an Intentional Act of Violence (June, 2018) |
04-02 | Disability Retirement Waiver to Remain on Leave (September, 2013) |
08-04 | Judicial Disability Retirement Application (March, 2016) |
MSD46 | Disability Appeal (September, 2013) |
DROP Applications
08-03 | Judicial Application for DROP (June, 2023) |
08-06 | Judicial Certification of Employment After DROP (April, 2023) |
09-01 | Application for Deferred Retirement Option Plan (DROP) (June, 2023) |
09-01A | Application for Deferred Retirement Option Plan (DROP) (June, 2023) |
09-02 | Certification at End of Employment (April, 2023) |
09-02A | Certification of Continued Employment After DROP Participation (May, 2016) |
11-02 | Harbor Police Retirement Plan (HARP) Certification of Continued Employment after DROP (May, 2016) |
11-03 | Harbor Police Retirement Plan (HARP) Deferred Retirement Option Plan Agreement/Penalties Per Statute (May, 2016) |
Enrollment Forms
01-01 | Membership Registration (March, 2021) |
01-03 | Notice of Membership Election A (September, 2017) |
01-05 | Notice of Membership Election C (September, 2017) |
01-10 | Certification of Membership in a State System Prior to July 1, 2015 (September, 2015) |
01-11 | Certification of Prior Employment in a Hazardous Duty Position (May, 2016) |
01-12 | Enrollment Information (December, 2015) |
01-13 | Benefit Forfeiture (November, 2012) |
02-18 | Hazardous Duty Services Plan Election (June, 2018) |
16-01 | DPSC Election Agreement Employed Prior to 01/01/02 (October, 2010) |
16-02 | Dept of Public Safety & Corrections (October, 2010) |
16-04 | Certification of Adult Probation and Parole Officer Employment (October, 2014) |
Insurance Form
06-02 | Insurance Premium Deduction Authorization (October, 2013) |
Leave Form
07-01 | Certification of Unused Annual and Sick Leave (January, 2017) |
Payroll Forms
FIS | Agency ACH Authorization (December, 2017) |
FIS26 | Payroll Cutoff Dates (January, 2011) |
Purchases of Service
02-05 | Certification for Purchase of In-State Service (February, 2013) |
02-08 | Application for Purchase of Certain Service by Legislators (February, 2013) |
02-10 | Application for Purchase of Leave (June, 2016) |
02-10B | Breakdown of Contributions (October, 2020) |
02-17 | Application for Purchase of Furlough Time (November, 2009) |
02-19 | Application to Transfer/Upgrade Service into the Hazardous Duty Services Plan (March, 2021) |
16-03 | Dept of Public Safety & Corrections Upgrade Invoice Request (July, 2017) |
Re-employed Retirees
10-02 | Re-employment of Retiree (May, 2017) |
10-02A | Reemployment of Disability Retiree (November, 2014) |
10-02B | Reemployed Retiree Option 3 Certification at End of Employment (April, 2023) |
10-02C | Reemployed Retiree Option 1A or 1B Certification at End of Employment (February, 2013) |
Retirement Applications
04-09 | Self-Funded COLA Election (August, 2019) |
06-01 | Application for Retirement (April, 2023) |
06-01A | Application for Retirement IBO after 01/01/2004 (April, 2023) |
06-01B | Application for Retirement IBO on or Before 01/01/2004 (April, 2023) |
08-01 | Judicial Application for Retirement (April, 2023) |
08-02A | Judicial Application for Retirement with Initial Benefit Option (if Eligible after January 1, 2004) (April, 2023) |
08-02B | Judicial Application for Retirement with Initial Benefit Option (if Eligible on or before January 1, 2004) (April, 2023) |
11-01 | Harbor Police Retirement Plan (HARP) Application for Retirement (April, 2023) |
Survivor Applications
03-01 | Application for Survivor Benefit (April, 2023) |
03-01A | Certification of Death from an Intentional Act of Violence (October, 2018) |
MSD52 | Certification for Disabled Survivor (September, 2019) |