If you would like to request one of the forms listed below, please contact us at (501) 682-1517.

Form # 25 - Beneficiary Designation Form

Form # 9 - Lump Sum Death Benefit - Beneficiary Designation Form

Form # 6a - Change of Address Form

Form # 315 - Direct Deposit Authorization

Form # 101 - Application for Refund of Contributions

Form # 322 - Cash Balance Account (CBA) Distribution Request

Form # 323 - Recurring Monthly Cash Balance Account (CBA) Distribution Request

Form # 335 - Annuity Option Change Form

 

The forms listed below are available in PDF format. The forms may be viewed and printed using Acrobat Reader​. If you are unable to view or print these forms please contact us at (501) 682-1517 to request that a form be mailed to you.

 

Benefit Verification | Change in Personal Status | Retirement | Service Credit 

 

Benefit Verification

Benefit and Address Verification Affidavit   

 

Change in Personal Status

Change of Name Form

Contributory Status Change

Irrevocable Contributory Election Form

Divorce

Model QDRO (pdf)     Model QDRO (Word)

Alternate Payee Enrollment Form

Alternate Payee Address/Name Change

 

Retirement

Retirement Application (ACTIVE Member) - use this form if you are currently employed with an ATRS employer and wish to apply for monthly ATRS benefits.

Retirement Application (INACTIVE Member) - use this form to apply for monthly benefits if you qualify for retirement benefits but have not been an active (working) member during the last fiscal year.

Retirement Application (T-DROP Participant) - use this form if you are a T-DROP participant applying for monthly ATRS retirement benefits.

Request for Taxpayer Identification Number (TIN) and Certification - use this form for Taxpayer Identification (TIN) and Certification.

Tax Bulletin - Special tax notice regarding refunds of before taxed contributions and interest.

Federal and State Tax Election Form - use this form to set federal and state tax withholdings.

           

T-DROP

T-DROP Application - use this form to apply for participation in the Arkansas Teacher Deferred Retirement Option Plan (T-DROP).

T-DROP Account Distribution Request - use this form when applying for monthly ATRS retirement benefits to direct distribution of your T-DROP funds at retirement.

 

Service Credit

Affidavit of Salary Statement for Service - use this form to certify time worked in an Arkansas Public School that was not reported to ATRS.

Affidavit of Out-of-State Teaching Service - use this for to certify time worked in an out-of-state public school.

Affidavit of Certified Service in a Private School - use this form to certify time worked in a private school.

Application for Free Military Service Credit - use this form to apply for military service as eligible for credit in ATRS.

Application for Purchase of Military Service - use this form to apply for purchase of military service.

Request to Establish Reciprocal Service Credit - use this form to acknowledge service from other State of Arkansas supported retirement plans.

Request to Establish Reciprocal Service Credit with an Alternate Plan - use this form to acknowledge service from other supported retirement plans.