Account Maintenance Forms

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To maintain an account when you are receiving a retirement benefit, you need a form for…

Authorizing Direct Deposit	Form 170
Survivor's Benefit: Authorizing Direct Deposit	Form 170S
Choosing Income Tax Withholding Preferences	Form 290
Updating Your Addresses or Name	Form COA
Instructions for Selecting Retiree Health Coverage Through the State Health Plan Online. For assistance with enrollment and detailed instructions, refer to Form HMOnlineIn in ORBIT.	Form HMOnline
If selecting retiree health coverage through the State Health Plan is not possible through Orbit, use Form HM.	Form HM

To maintain an account when you are receiving a Transfer Benefit, you need a
Transfer Benefit or Tax Withholding form for…

Authorizing Direct Deposit for the NC 401(k) Transfer Benefit	Form 170401k
Authorizing Direct Deposit for the NC Deferred Compensation (457) Transfer Benefit	Form 170457
Choosing Income Tax Withholding Preferences for the NC 401(k) Transfer Benefit	Form 290401k
Choosing Income Tax Withholding Preferences for the NC Deferred Compensation (457) Transfer Benefit	Form 290457

To maintain an account while you are receiving a disability benefit, you need a form for…

Reporting Your 2010 Income To Continue Your Retirement System Disability Benefit	Form 237
Reporting Your 2010 Income To Continue Your Benefit Through the Disability Income Plan	Form 296
Reporting Your 2010 Income to Continue Your Disability Salary Continuation Plan Benefit	Form 297
Medical Report for Eligibility Review of Short-Term Disability Benefits	Form 7AR
Reporting Earnings to Your Employer During the Short Term	Form 702
Medical Report for Eligibility Review of Short-Term Disability Benefits	Form 703
Agreeing to Accept Long-Term Benefits through the Disability Income Plan of N.C.	Form 705
Reporting Earnings Monthly While Receiving Extended Short-Term or Long-Term Benefits	Form 707