Section C: Beneciary information
You may name only one beneciary.
• Enter the rst name of your beneciary (last name is optional) and their date of birth so we can provide the full- and
half-survivorship options.
• If you leave this section blank, we cannot provide estimates for survivorship options.
• Estates and trusts may not be named as beneciary for any OPSRP retirement option.
• The younger your beneciary is, the lower your survivorship option benets will be. (Survivorship options include
full-survivorship, half-survivorship, full-survivorship increase, and half-survivorship increase.)
• Providing a beneciary for your benet estimate does not impact your preretirement beneciary prescribed
by statute.
Oregon Public Service Retirement Plan (OPSRP)
Estimate Request
Important: Read instructions before you complete and submit the attached form.
General instructions
Section A: Member information
Section B: Retirement date and PERS employer name
Two estimates will be provided free of charge in a calendar year. We can only provide estimates for retirement dates
within the upcoming 24 months.
The retirement date entered must be after the date employed, must be after the date PERS receives your form and must
be within the upcoming 24 months.
We are unable to advise exactly when your request will be processed. PERS processes many written benet estimate
requests in retirement date order, with the earliest retirement dates rst. Estimate processing time may vary from
member to member as each account is dierent.
•
Enter the last day you were employed or the last day you expect to be employed.
• Enter the name of your current or most recent PERS employer.
• Enter the month and year you wish to retire. Retirement dates are always on the rst of the month. You can use only one
date per estimate request.
• Type or print clearly in dark ink. Illegible forms may be returned, which could delay your request.
• Sign the bottom of the form, and mail to PERS at PO Box 23700, Tigard OR 97281-3700, or fax it to Member
Services at 503-598-0561.
Fill in the member information section completely.
• Enter your Social Security number (SSN) and your PERS ID. If you do not know your PERS ID, leave the PERS ID
field blank. Your PERS ID can be found on your annual statement(s). Providing your SSN is also optional; however,
providing at least one of these IDs assists in locating your account.
• Enter your mailing address. If you recently moved and you are:
• Currently employed in a PERS-covered position, you must inform your employer of your new address.
• No longer employed in a PERS-covered position, complete the Information Change Request form.
• Enter your date of birth.
• Enter your home, work, and cell phone numbers including the area codes. Include an extension number if you have one.
• Enter your personal email address. Confirmation and followup letters are sent via email whenever possible.
Sign the form, and mail to PERS at PO Box 23700, Tigard OR 97281-3700, or fax it to Member Services at 503-598-0561.
Section D: Signature
11410 SW 68th Parkway, Tigard OR 97223
Mailing Address – PO Box 23700, Tigard OR 97281-3700
Toll free – 888-320-7377 Fax – 503-598-0561
Website – https://oregon.gov/pers
Information page for form #459-533 (7/31/2023) SL-3 IIM Code: 29984
Form #459-533 (7/31/2023) SL-3 IIM Code: 29984
Oregon Public Service Retirement Plan (OPSRP)
Estimate Request
Section A: Member information
(Type or print clearly in dark ink. Illegible forms could be returned to you, which could delay your request.)
In compliance with the Americans with Disabilities Act, PERS will provide help filling out this form upon request. You may request help by calling toll free 888-320-7377 or TTY 503-603-7766.
This form is strictly for the OPSRP Pension Program. Call PERS or visit our website if this is not the form you need.
First name MI Last name Social Security number*
Mailing address (street or PO box) PERS ID (optional)
City State ZIP code Country Date of birth (mm/dd/yyyy)
Home phone number Work phone number Cellphone number Personal email
*Providing your Social Security number (SSN) is voluntary. It will be used for conrmation purposes. If you choose not to supply your SSN, it may take PERS sta longer to process your form.
Section C: Beneciary information
Beneficiary’s name Beneficiary’s date of birth
(mm/dd/yyyy)
Signature Date
Last day employed or last day you expect to be employed (mm/dd/yyyy) Name of current or most recent PERS employer
Note: Only one retirement date per form.
You may name only one beneciary.
Section B: Retirement date and PERS employer name
Section D: Signature
11410 SW 68th Parkway, Tigard OR 97223
Mailing Address – PO Box 23700, Tigard OR 97281-3700
Toll free – 888-320-7377 Fax – 503-598-0561
Website – https://oregon.gov/pers
My retirement date is the rst day of: **
_______________________ _____________________
Month Year
** The month and year you enter above, must be after the date PERS receives your form and must be within the upcoming 24 months.
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