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Category: Retirement and 401k / 457 Plan Forms

Savings Plans Direct Deposit for One-time Payments

Use this form for a direct deposit of one-time payments from your Utah Retirement Systems (URS) Savings Plans (401(k), 457, and IRAs). Completed forms can be sent directly to URS at fax number 801-366-7445. URS Savings Plans Direct Deposit for One-time Payments

URS Tier II Request for Exemption Form

Complete this form to opt out of Tier II defined contribution vesting. Completed forms can be sent directly to Utah Retirement Systems (URS) at fax number 801-366-7759. URS Tier II Request for Exemption Form

URS Statement of Ineligibility

This form notifies URS when an employee is not eligible for retirement benefits and also notifies the employee they can contribute on their own to a 401k account if they choose to do so.  This certification is normally part of the Onboarding process completed by the Employee Resource Information Center. URS Statement of Ineligibility 1/2014

URS Leave Notification Form

This form notifies URS when an employee is out on Leave Without Pay status so retirement benefits can be adjusted as necessary. URS Leave Notification

URS Eligibility Certification Form

This form notifies Utah Retirement Systems an employee is eligible for retirement benefits.  An authorized signature is required and this process is normally part of the Onboarding process of a new state employee. URS Eligiblity Certification Form

URS Beneficiary Designation Form

Complete this form to designate or update beneficiary information with Utah Retirement Systems, completed forms may be faxed directly to URS at 801-366-7759. URS Beneficiary Designation Form

URS 457 Withdrawal/Rollover Form

Complete this form to rollover eligible funds to your URS 457 account or to withdraw funds upon leaving state employment. 2015 URS 457 Withdrawl/Rollover Form

URS 401k Withdrawal/Rollover Form

Complete this form to either rollover funds from a previous employer or to withdraw funds from your URS 401(k) account if you are leaving state employment.  2015 URS 401(k) Withdrawal/Rollover Form

Tier I DB Opt Out Form

Complete this form to opt out of defined benefit coverage. Completed forms can be sent directly to Utah Retirement Systems (URS) at fax number 801-366-7759. URS Tier 1 Request for Exemption from DB coverage

Post (After) Retirement Employment Form

Complete this form when you are rehired retiree to acknowledge you have read the Explanation of Post Retirement Employment Restrictions and understand.  2015 Post (After) Retirement Employment Form

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