EMERGENCY MEDICAL SERVICES RETIREMENT SYSTEM (EMSRS) Forms

• Application for Scholarship
• Authorization to Release Information
• Benefit Estimate Request
• Confidential Records Order
• Employee of the Month Nomination Form
• Insurable Interest Affidavit
• Less Than Honorable Service
• Membership Enrollment
• Online Self-Service Get Started Guide
• Pre-Retirement Beneficiary Designation
• Qualified Domestic Relations Order (QDRO)
• Request for Disability Packet
• Request to Purchase Permissive Service Credit (Rollover)
• Request for Quote for Additional Contributions and Interest Due on Transferred 911 Service
• Retired Public Safety Officer Authorization for Insurance Premium Deduction (PSOA-2024)
• Retired Public Safety Officer Authorization for Insurance Premium Deduction (PSOA-2025)
• Retired Public Safety Officer Insurance Carrier (ICA)
• State of West Virginia Statutory Form Power of Attorney