Public Safety Personnel Retirement System

State of Arizona

Official Website: https://www.psprs.com/

Forms & Documents

Browse all Public Safety Personnel Retirement System government forms

81 - 100 of 132 forms

Form Title Topics
HIPAA – Request for Amendment of PHI (not required for packet or claims)
HIPAA – Request for Amendment of PHI (not required for packet or claims)
HIPAA – Request for Restriction of PHI (not required for packet or claims)
HIPAA – Request for Restriction of PHI (not required for packet or claims)
HIPAA – Request for Restriction of PHI (not required for packet or claims)
Local Board Oath of Office
Lump Sum Distribution Form for REFUNDS (Form U3 – Refunds) (2 of 2 required docs)
Lump Sum Distribution Form for REFUNDS (Form U3 – Refunds) (2 of 2 required docs)
Out of State Service Affidavit (Employee) (Form OSS)
Power of Attorney (POA) Template (Provided by Maricopa County Superior Court)
Power of Attorney (POA) Template (Provided by Maricopa County Superior Court)
Power of Attorney (POA) Template (Provided by Maricopa County Superior Court)
PS DROP & CORP Reverse DROP Rollover Acknowledgement (for Primary Members only)
PS DROP & CORP Reverse DROP Rollover Acknowledgement (For Primary Members Only)
PSPRS Affidavit to Redeem Prior Rural Metro Contract Service (Form P2A)
PSPRS and CORP Cancer Insurance Attending Physician Statement (3 of 4 required docs)
PSPRS and CORP Cancer Insurance Attending Physician Statement (3 of 4 required docs)
PSPRS and CORP Cancer Insurance Attending Physician Statement (3 of 4 required docs)
PSPRS and CORP Cancer Insurance Combined-Supplemental and Pharmacy Benefits claim form (used after Initial Claim is filed)
PSPRS and CORP Cancer Insurance Combined-Supplemental and Pharmacy Benefits claim form (used after Initial Claim is filed)

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