Friday, December 14, 2018

MERS Forms

Legend:

= Available on myMERS. Forms with a star may be completed Online by logging into your myMERS account. Click here to log in.
 
Abbreviations
DB = Defined Benefit, DC = Defined Contribution, DC+ = Defined Contribution Plus, HCSP = Health Care Savings Program, RHFV = Retiree Health Funding Vehicle, ISP = Investment Services Program, Premier Adv = Premier Advantage, Annuity = Stable Income Annuity, GL&D = Group Life & Disability Insurance.

Disability

Form # Product Name Audience myMers Info
F-54 DB Psychiatric Medical Report Employer, Participant False more information

Psychiatric Medical Report

Form #: F-54

Product: DB
Audience: Employer, Participant

F-53 DB Physician's Statement of Disability Employer, Participant False more information

Physician's Statement of Disability

Form #: F-53

Product: DB
Audience: Employer, Participant

F-52 DB Limitation on Disability Benefits – Affidavit Participant False more information

Limitation on Disability Benefits – Affidavit

Form #: F-52

Product: DB
Audience: Participant

F-51 DB Application for Disability Retirement Employer, Participant False more information

Application for Disability Retirement

Form #: F-51

Product: DB
Audience: Employer, Participant

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Disclaimer
The information contained in this Web site is being made available as a public service. The information is not intended to constitute legal or investment advice, or to replace official versions of that information. Benefit Estimates or Service Credit Purchase estimates requested through this Web site are not official descriptions of any benefits, and do not represent a promise by MERS to provide any benefit(s) to any person(s). No one can detrimentally rely upon the information provided in, or requested through this Web site. MERS reserves the right to correct any errors, and presents this information without warranties, express or implied, regarding the information?s accuracy, timeliness or completeness. If you believe the information is inaccurate, out-of-date, or incomplete, or if you have problems accessing or reading the information, please call MERS at 800.767.MERS (6377).