Death Reporting And Related Forms

Click here to go back to the main forms page

To report a death, the member's survivors should submit a certified copy of a Certificate of Death. You, the employer, should submit the following form for:


Reporting an Employee's Work Record in the Event of Death

Form 253


We will send the applicable beneficiaries the appropriate forms, which may be forms for…

Choosing Tax Treatment for a Payment of Undistributed Contributions Due to a Death

Form DB228

Survivor's Benefit: Authorizing Direct Deposit

Form 170S

Survivor's Benefit: Choosing Income Tax Withholding Preferences

Form 290S

If the employee's work record meets certain requirements (approximately eligible for retirement at the time of death), a single principle beneficiary may have a choice between two benefits. We will mail the forms to any applicable beneficiary.

Choosing the Return of Contributions

Sample 5ROC

Choosing the Survivor's Alternate Benefit

Sample 6SAB