Forms

Downloadable PDF forms

In the links below are the forms most commonly used by members and employers to request a service from KCERA. An incomplete form will delay your request, so please follow instructions carefully before submitting the document(s) to KCERA.

(To view the documents on this webpage, you will need Adobe Acrobat Reader installed on your computer. If you do not have the most recent version, you can download it for free by clicking here.)

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Member Forms

Address/Direct Deposit Change Request Form Authorization for Release of Member Information Beneficiary Designation - Member Form Beneficiary Designation - Survivor Form Beneficiary Designation - Alternate Payee Form California Tax Withholding Form DE 4P Certification of Prior County/District Service Certification of Prior Public Service Certification of Prior Public Service - Military Direct Deposit Stop Disposition Packet DRO Sample Email Change Form Federal Tax Withholding Form W-4P Name Change Request Form Power of Attorney Packet Purchase of Service - FAQ Retirement Application Packet

Employer Forms

Payroll Training Manual (compiled).pdf Post-Retirement Employment of County Retiree - Certification Form Post-Retirement Employment of Plan Sponsor Retiree - Certification Form Special Pay Code Request Form

Forms

Downloadable PDF forms

Contact Member Services

Contact the Legal Team