Forms for Active Employees

• Automatic Withdrawal Cancellation of Insurance Premiums - ERS GI 2.945 (pdf)
• Choose to Quit Certification Form - ERS 2.958 (pdf)
• Dependent Child Certification - ERS GI-1.081 (pdf)
• Disability Retirement Packet - ERS 2.11 (pdf)
• Request or Renew Health Coverage for a Disabled Dependent Child - ERS 2.654 (pdf)
• Securian/Minnesota Life
• Tobacco Use Certification Form  - ERS 2.933 (pdf)
• Verification of Insurance  - ERS 2.837 (pdf)
• Verification of Optional Retirement Program Participation  - ERS 2.613 (pdf)