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  • EMPLOYER FORMS

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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)
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LASERS

MAILING ADDRESS:
P.O. Box 44213
Baton Rouge, LA 70804-4213

STREET ADDRESS:
8401 United Plaza Boulevard, 1st Floor
Baton Rouge, LA 70809

BENEFITS

Speak to a Retirement Benefits Analyst Monday - Friday, 7:30 a.m. - 4:00 p.m.

Local: 225.922.0600
Toll-free: 800.256.3000
Fax: 225.935.2856

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