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Retirement Systems of Alabama (RSA) Forms

Address Change Notification

Address Change Notification.pdf 85.26 KB (Last Modified on August 24, 2023)

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Designation of Beneficiary Prior to Retirement

Designation of Beneficiary Prior to etirement.pdf 150.33 KB (Last Modified on August 24, 2023)

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RSA-1 Enrollment Packet

Enrollment Packet.pdf 583.64 KB (Last Modified on March 4, 2022)

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Public Education Employees' Health Insurance Plan (PEEHIP) Forms

New Enrollment and Status Change

New Enrollment Status Change PEEHIP.pdf 105.57 KB (Last Modified on August 24, 2023)

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Wellness Screening Form

Wellness Screening Form.pdf 169.93 KB (Last Modified on August 24, 2023)

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Flexible Spending Account Application (effective 10/1/2023)

Flexible Spending Accoutn Enrollment Application 10 1.pdf 77.05 KB (Last Modified on August 24, 2023)

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Premium Assistance Application

Premium Assistance PEEHIP.pdf 83.34 KB (Last Modified on August 24, 2023)

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Additional forms may be found on the Retirement Systems of Alabama website at https://www.rsa-al.gov.

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