Forms
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- Peach State Reserves Deferred Compensation Forms
- Retirement System Forms
- State Health and Flexible Benefits Plan Forms
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Form Title
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- 2024 Flexible Benefits Rate Sheet
- 2024 Flexible Benefits What’s New Brochure
- 2024 Flexible Benefits You Decide Guide
- 2024 Flexible Benefits-at-a-Glance
- 2024 State Health Benefit Plan Active Member Decision Guide
- 2024 State Health Benefit Plan Active Member Rates
- 2024 State Health Benefit Plan Retiree Decision Guide
- 2024 State Health Benefit Plan Retiree Rates
- ADA Public Notice Statement & Grievance Procedure
- Affordable Care Act Model Notice
- All Peach State Reserves Deferred Compensation Information
- Assistant District Attorney Application
- Assistant District Attorney Appointment Order
- Assistant District Attorney Oath of Office
- BeWell SHBP Biometric Screening Form
- BeWell SHBP Biometric Screening Website
- Cell Phone Reimbursement Policy
- Certification for Serious Injury of a Current Servicemember
- Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave
- Certification of Health Care Provider for Employee’s Serious Health Condition
- Certification of Health Care Provider for Family Member’s Serious Health Condition
- Certification of Qualifying Exigency for Military Family Leave
- Chief Assistant District Attorney Appointment Order
- Chief Assistant District Attorney Oath of Office
- Child Labor Summary Sheet
- DA Investigator Appointment Order
- DA Investigator Oath of Office
- DA Victim Advocate Appointment Order
- Delegation of Authority – Absence Management
- Designation of Outstanding Wages
- Drug Custody Form (see your office manager)
- E-Verify
- EEOC
- Employee Confidentiality Agreement
- Employee Information Sheet (PDF)
- Employee’s Report of Injury
- Employment Application
- Employment Eligibility Form (I-9)
- ERS Group Term Life Insurance Form (New Plan ONLY)
- ERS Handbook
- Family and Medical Leave Request Form
- Federal Minimum Wage
- Flexible Benefits Employee Orientation Video
- Flexible Benefits Enrollment Portal (All Flexible Benefits forms, including beneficiary forms must be filled out online or call 1-877-342-7339)
- FMLA Employee Rights and Responsibilities Notice
- Food Stamp Payment Request Form
- GA Third-Year Law Student Oath
- GA Third-Year Practice Application for Order of Admission
- GA Third-Year Practice Order
- GaBreeze Quick Reference Guide
- GDCP Application for Refund of Contributions
- GDCP New Hire Letter (hourly new hires only)
- GDCP New Hire Letter (hourly new hires only)
- Georgia Hotel and Motel Tax Exemption
- Georgia United Credit Union Benefits Brochure
- Georgia United Credit Union Membership Kit
- Georgia United Credit Union Payroll Deduction Form
- Georgia United Credit Union Website
- GSEPS 401K Enrollment Information
- GSEPS Handbook
- GSEPS Opt In Form
- Hourly Time Sheet (for Circuit Use ONLY)
- Hourly Time Sheet (for PAC Atlanta use ONLY)
- Important Changes to 401K and 457
- Incident Only Notice (When no immediate injury or no treatment needed beyond first aid)
- Investigator Application
- JQC Referral Letter Template
- JQC Referral Packet
- JRS Change or Designation of Beneficiaries
- JRS Handbook
- JRS Membership Application (For District Attorneys ONLY)
- Leave Adjustment Form
- Live Health Virtual Visit
- Loyalty Oath
- Monthly State Vehicle Reporting Form (for employees assigned a state vehicle)
- Motor Vehicle Assignment and Use Authorization
- Municipal/Probate Prosecutor Registration Form
- New Hire Checklist – Circuit Use only
- New Hire Forms Checklist
- New Hire Onboarding Paperwork
- OSHA
- Out of State Travel Authorization
- Paid Parental Leave Request Form
- Path 2 College 529 Application (Optional College Savings Plan)
- Payment & Reimbursement Request
- Payroll Deduction Authorization (Peace Officers’ Annuity and Benefit Fund of GA)
- Peachcare FAQ
- Personnel Action Form (PAF)
- Purchase Request Form
- Purchase Requisition Form (for Circuits)
- Reporting of Injuries
- Request for Exemption to the Budget Neutral Hiring Policy
- SG Victim Advocate Appointment Order
- SHBP Enrollment Portal
- SHBP Enrollment Portal Quick Reference Guide
- SHBP Enrollment Portal User Guide
- Special Assistant District Attorney Oath of Office
- Standard Disability Benefit Claim Form
- State Vehicle Insurance Card
- Statement of Limitation of Practice (for Part-Time Solicitors-General)
- Suggested Rights Statement
- Supervisor Reporting Instructions
- Travel Reimbursement Form (2019)
- Unemployment Insurance
- USERRA Poster
- Victim Impact Restitution Form
- Victim Impact Restitution Form
- Victim Impact Statement (revised 2010)
- W9
- WC Bill of Rights
- WC Bill of Rights (to be displayed in office)
- WC Fraud
- WC Fraud Notice (to be displayed in office)
- WC/MCO at a Glance (to be displayed in office)
- WC/MCO Panel (to be displayed in office)
- Witness Report of Injury
GDCP Application for Refund of Contributions
Log into your ERSGA online account at www.ers.ga.gov to make changes to your beneficiary designations or to request a refund of your contributions and interest. Using your online account is fast, easy, and secure!
Requesting a Refund
If you are not able to apply for a refund online, please contact ERSGA for assistance at 404-350-6300.