PDF Icon All files are PDFs unless otherwise noted
  ACRA Enrollment Form 
  Beneficiary Change for Retirement Benefits 
  Cancellation Form for Major Medical Coverage 
  Direct Deposit Form 

Pension Benefit Estimate Form 

  Previous Contribution Withdrawal Repayment
Did you work for Allegheny County at some point in the past and upon separation did you receive a refund of your retirement contributions? If you have returned to employment with Allegheny County you have the ability to regain your previous service time by repaying the contributions you were refunded along with interest. If you are interested, complete and submit this form to the Retirement Office.
  Qualified Domestic Relations Order (Sample) 
  Right to Know Policy
     Right to Know Request Form  
  Implementing the Right-to-Know Law (policy & forms included)  
  Service Credit for Active Duty Military
Under federal law the Allegheny County Employees’ Retirement System has obligations to meet for its members who are active servicemen and servicewomen of the United States military.
  Service Credit for Military Prior to Employment
The PA Second Class County Code allows members of the Allegheny County Employees’ Retirement System to gain additional service credit for time spent in the United States military prior to their employment with Allegheny County.
  Six-Month Waiver Repayment 
  Summary of Act 125 
This summary is included on the ACERS membership application to new employees during orientation.  The membership application also identifies beneficiaries and 6 month waiver option.
  Survivorship Form 
Your signature on this form must be witnessed by a notary (Individual Acknowledgement Form is attached). Vested Employees may elect this option. This option is irrevocable, if enacted, when an Active Employee passes the age of 50 and for any Retiring Employee who elects this option at the time your retirement paperwork is submitted. For information on the cost of this benefit, please contact the retirement office.
  W-4P Form