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District of Columbia Retirement Board
 

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DCRB Member Forms - Draft

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.

 

Retired Members

General Forms

  1. Change of Contact Information
  2. Change of Name Form
  3. Contribution Balance Request Form
  4. DCRB Durable Power of Attorney
  5. Electronic Funds Transfer (Direct Deposit) Form
  6. Request for Information from Retirement File
  7. Verification of Pension Benefits Form
  8. Verification of Receipt of Annuity Payment
 
 

Disability Annuity

  1. Disability Annual Earned Income Report
  2. IRS Request for Transcript of Tax Return Form 4506-T
  3. Reconsideration of DCRB’s Decision Earned Income Review
 
 

Health Insurance

  1. FEDERAL: Health Benefits Election Form
  2. DISTRICT: Health Benefits Registration Form
  3. DISTRICT: Temporary Continuation of Coverage Benefits Enrollment Form
  4. Health Coverage Certification for Grandchildren

Life Insurance (Members)

  1. FEDERAL: Employees' Group Life Insurance Program Election Form (FEGLI) - SF 2817
  2. DISTRICT: DC Employees’ Group Life Insurance Program Form (DCEGLI)
 
 

Life Insurance (Beneficiary)

  1. FEDERAL: Federal (FEGLI) Designation of Beneficiary Form – SF 2823
  2. DISTRICT: DC Life Insurance Designation Form
 
 

Pension Beneficiary Designation Forms

  1. Beneficiary Designation Form - Police and Fire [PDF]
  2. Beneficiary Designation Form - Teachers [PDF]
 
 

Tax Forms

  1. Federal W-4P Withholding Certificate for Pension or Annuity Payments
  2. DC Tax Withholding Form
  3. MD Tax Withholding Form
  4. VA Tax Withholding Form

Active Members

Post-1956 Military Service

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

Special Forms (Police/Fire)

  1. Calculation Request Form Police/Fire
  2. Claim for Unpaid Survivor Annuity Payment
  3. EMS Lateral Transfer Service Credit Calculation Request Form
  4. Tier Change Calculation Request Form

Survivors

General Forms

  1. Change of Contact Information
  2. Change of Name Form
  3. DCRB Durable Power of Attorney
  4. Electronic Funds Transfer (Direct Deposit) Form
  5. Periodic Certification of Full-Time School Attendance
  6. Request for Information from Retirement File
  7. Verification of Pension Benefits Form
  8. Verification of Receipt of Annuity Payment
 
 

Health Insurance

  1. FEDERAL: Health Benefits Election Form
  2. DISTRICT: Health Benefits Registration Form
  3. DISTRICT: Temporary Continuation of Coverage Benefits Enrollment Form
  4. Health Coverage Certification for Grandchildren
 
 

Survivor Change of Status Forms

  1. Surviving Child Change of Status - Police Officers' and Firefighters' Plan
  2. Surviving Spouse Change of Status - Police Officers' and Firefighters' Plan
  3. Surviving Child Change of Status - Teachers' Plan
  4. Surviving Spouse Change of Status - Teachers' Plan

Other (Non-active Members and Non-retirees)

General Forms

  1. Contribution Balance Request Form
  2. Request for Information from Retirement File
 
 

Deferred Retirement

  1. Application for Deferred Retirement Annuity - Police and Fire
  2. Application for Deferred Retirement Annuity - Teachers
  3. Application for Payment of Deceased Member Contributions - Teachers
 
 

Refunds of Contribution Forms

  1. Application for Refunds of Contributions
Service Contact: 
Member Services Center
Contact Phone: 
(202) 343-3272
Contact Fax: 
(202) 566-5001
Contact TTY: 
711
Office Hours: 
8:30 am to 5:00 pm

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