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District of Columbia Retirement Board
 

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DCRB Member Forms

The District of Columbia Retirement Board (DCRB) offers several of its forms online for members of the District of Columbia Police Officers and Firefighters' Retirement Plan and the District of Columbia Teachers' Retirement Plan.

You should not email any forms, documents, or inquires containing PII to DCRB, effective September 21, 2020. Please see our frequently asked questions on Submitting DCRB Forms Securely.

To protect and secure your Personally Identifiable Information (PII), please send your completed forms and any required attachments by fax to (202) 566 -5001. 

You can also mail your documents to DCRB at the mailing address below:

DC Retirement Board
Member Services Center
900 7th Street, NW, Second Floor
Washington, DC 20001

*Please note that some of the forms must be signed in the presence of a notary public.

General Forms
 Change of Address Form 
 Change of Name Form
 Electronic Funds Transfer (Direct Deposit) Form

Refunds of Contribution Forms
Application for Refunds of Contributions

Deferred Retirement
Police Officers and Firefighters
Application for Deferred Retirement Annuity - Police and Fire

Teachers
Application for Deferred Retirement Annuity - Teachers

Health Care Forms
Federal
Federal Health Benefits Election Form 

District
District Health Benefits Registration Form
District of Columbia Temporary Continuation of Coverage Benefits Enrollment Form

All Members
Health Coverage Certification for Grandchildren

Life Insurance Forms
Federal Employees' Group Life Insurance Program Election Form (FEGLI) - SF 2817
DC Employees’ Group Life Insurance Program Form (DCEGLI)

Life Insurance Beneficiary Forms
Federal (FEGLI) Designation of Beneficiary Form – SF 2823
DC Life Insurance Designation Form

Pension Beneficiary Designation Forms
Beneficiary Designation Form - Police and Fire [PDF]  
Beneficiary Designation Form - Teachers [PDF]

Post-1956 Military Service
OPM Estimated Earnings During Military Service Form (RI 20-97
Post-56 Military Service Purchase of Service Election Form 
Post-1956 Military Service Facts 
List of Military Finance Centers 

Special Forms
Police/Fire
Calculation Request Form Police/Fire
Claim for Unpaid Survivor Annuity Payment
EMS Lateral Transfer Service Credit Calculation Request Form
Tier Change Calculation Request Form

Teachers
Application for Payment of Deceased Member Contributions - Teachers

All Members
Authorization for Release of Confidential Information
Contribution Balance Request Form
Disability Annual Earned Income Report
DCRB Durable Power of Attorney
Periodic Certification of Full-Time School Attendance
Reconsideration of DCRB’s Decision Earned Income Review
Request for Information from Retirement File
Verification of Pension Benefits Form
Verification of Receipt of Annuity Payment

Survivor Change of Status Forms
Police Officers and Firefighters
Surviving Child Change of Status - Police Officers' and Firefighters' Plan
Surviving Spouse Change of Status - Police Officers' and Firefighters' Plan

Teachers
Surviving Child Change of Status - Teachers' Plan
Surviving Spouse Change of Status - Teachers' Plan

Tax Forms
IRS Request for Transcript of Tax Return Form 4506-T
Federal W-4P Withholding Certificate for Pension or Annuity Payments
DC Tax Withholding Form
MD Tax Withholding Form
VA Tax Withholding Form

Service Contact: 
Member Services Center
Contact Phone: 
(202) 343-3272
Contact Fax: 
(202) 566-5001
Office Hours: 
8:30 am to 5:00 pm