Active Member Forms

• Address/Name Change
• Alternate Payee Benefit application - MPO
• Authorized Leave Notice
• Beneficiary Designation
• Benefit Handbook
• Common Law Marriage Application
• Contribution Income Verification Request
• Death Notification
• Disability Retirement Packet
• DROP Distribution Form
• DROP Enrollment & Beneficiary Form
• POR Service Credit Transfer
• Purchase Service Credit Request Form
• Refund Application
• Sample Marital Property Order (MPO)
• Service Retirement Application

Active Member Medical Protocol Forms

Fire

• Medical History Questionnaire Form (Applicant Completes)
• Occupational History Questionnaire Form (Applicant Completes)
• Medical Examination Form (Physician Completes)
• NFPA 1582 Standard On Comprehensive Occupational Medical Program for Fire Departments (Chapter 6)
• MMPI Suitability Certification Form (Psychologist Completes)
• Minnesota Multiphasic Personality Inventory-3 (MMPI-3) Firefighter Candidate Interpretive Report
• Essential Functions - Firefighter
• Protocol Summary Checklist

Terminated Member Forms

• Beneficiary Designation
• Refund Application

Retiree & Beneficiary Forms

• 2025 Federal W-4P
• 2025 Iowa W-4P
• 2023 Iowa Tax Withholding Update
• Address/Name Change
• Alternate Payee Benefit application - MPO
• Benefit Handbook
• Children's Education Affidavit
• Death Notification
• Direct Deposit
• Duplicate 1099R Request
• Duplicate Deposit Notification Request
• Earnings Test Statement of Compliance
• Income Verification Request
• Representative Payee Application
• Sample Marital Property Order

Police

• Medical History Questionnaire Form (Applicant Completes)
• Occupational History Questionnaire Form (Applicant Completes)
• Medical Examination Form (Physician Completes)
• ACOEM Guidance for Medical Evaluation of Law Enforcement Officers
• MMPI Suitability Certification Form (Psychologist Completes)
• Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
• Minnesota Multiphasic Personality Inventory-3 (MMPI-3) Police Candidate Interpretive Report
• Essential Functions - Police Officer
• Protocol Summary Checklist