Retiree Forms

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Retiree Forms

$7000 Burial Benefit Designation / Change of
Beneficiary Form (Form GL) Change of Address

Dental Insurance Application
or Refusal Deposit Authorization Form
(Form DA) Vision Insurance Application
or Refusal
Healthcare Application:
Aetna/Highmark Healthcare Application
Special Medicfill Medicare Health Plan
Waiver/Termination

Adult Dependent Coordination of
Benefits Information

CVS Mail Order Process
for Non-Medicare

CVS/SilverScript Mail Order Process
for Medicare Eligible

Priority of Eligible Survivors
(Form SOP-1) Qualified Domestic Relations Order

Spousal Coordination of
Benefits Information

Pension Contribution Designation / Change of
Beneficiary Form (Form BEN-1)

Tax Forms

Pensioners may request that Federal and Delaware state taxes be withheld from their retirement monthly pension benefit. The Office of Pensions does not withhold state taxes for any state other than Delaware.
You can update your tax withholding by completing and submitting a new form(s), they will replace your current withholdings:

IRS W-4P Form

State of Delaware Tax Withholding
In Lieu of DE-W4

You can submit the form(s) to the Office of Pensions by mail, email: pensionoffice@delaware.gov or by fax: (302)739-6129.

The Office of Pensions staff cannot provide tax advice. If you have specific questions regarding taxes, you may wish to consult with a qualified tax adviser.

Social Security Forms

Medicare Part B Application
(CMS-40B) Request for Employment Information
(CMS L564/R297) Medicare Resource Guide

Bundled Forms

Health Care Forms
Zipped Bundle

Payroll Forms
Zipped Bundle

In order to read the forms in .PDF Format, you must have Adobe's Acrobat Reader installed on your computer. If you don't already have this utility, you can download a free copy from Adobe's Web Site by clicking on the Acrobat Reader icon, below.

Retiree Forms

Virtual
SEPP Pre-Retirement Workshop

Government and Services

Retiree Forms

Virtual SEPP Pre-Retirement Workshop

Government and Services

Virtual
SEPP Pre-Retirement Workshop