Disabled Member Forms

• Application for Disability Benefits – to be completed by an active sheriff applying for Disability Benefits.

• Application for Survivor Benefits Disabled Member – to be completed by the surviving spouse of a vested member who was receiving disability leave benefits. Not available for download. Contact the Sheriffs’ Retirement System office as soon as possible to report the death of the member and determine any survivor benefits available.

• Direct Deposit Authorization Form – to be used to provide financial information for direct deposit of your disability benefit. Please contact the Sheriffs’ Retirement System to obtain this form.

• Withholding Certificates for Pension or Annuity Statements:
  • IRS Form W-4P – to be completed for Federal Withholding Amounts.
  • Missouri Form MO W-4P – to be completed for State of Missouri Withholding Amounts. 

• Address or Other Information Change Form – to notify the Sheriffs’ Retirement System of changes to the information on file for the member.