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
Form # 306 - Alternate Payee Change of Address/Name Form
ATRS Model QDRO 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
Irrevocable Contributory Election Form
Divorce
Alternate Payee Enrollment Form
Alternate Payee Address/Name Change
Retirement
Retirement Application (ACTIVE Member) - use this packet if you are currently employed with an ATRS employer and wish to apply for monthly ATRS benefits
Retirement Application (INACTIVE Member) - use this packet 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 packet 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)
Retirement Application (T-DROP Participant) - use this packet if you are a T-DROP participant applying for monthly ATRS retirement benefits
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 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
Request to Correct Service History - use this form to report inaccurate service history