NC TSERS Death Benefit Claim Forms and Documents Needed

Forms the Employer Handles

Form 253 — Reporting an Employee's Work Record in the Event of Death

When an active TSERS member dies, the Retirement Systems Division sends Form 253 directly to the member's employing agency. The employer — not the family — completes this form. It certifies the member's final compensation, final month's pay, accrued unused sick leave, and whether the employee was actively working, receiving Disability Income Plan benefits, or on Workers' Compensation at the time of death.

Unused sick leave is recorded on Form 253, but it does not count toward the Survivor's Alternate Benefit 20-year eligibility threshold. If the reported balance is wrong, ask the HR department to correct its records before Form 253 goes back to RSD.

Forms the Beneficiary Handles

Form 2C — Designating Beneficiaries

Form 2C is the beneficiary designation form for active members. It names who receives the Return of Contributions and the Lump-Sum Salary Death Benefit. By the time a death claim is being processed, the Form 2C on file (or the equivalent ORBIT digital designation) has already determined who gets what. The family does not file a new Form 2C — RSD audits the existing one.

Why this matters: if the member designated two or more co-beneficiaries on Form 2C, the Survivor's Alternate Benefit (the lifetime monthly pension) is legally disqualified. The pension-account payout is then a lump-sum Return of Contributions split between the named individuals. A separate Lump-Sum Salary Death Benefit may also be payable to its own named beneficiary if its eligibility requirements are met.

Form 170S — Survivor's Benefit: Authorizing Direct Deposit

Every survivor beneficiary must submit Form 170S to set up direct deposit for their monthly survivor pension or lump-sum payment. Include a voided check or a bank letter confirming your routing and account numbers.

Form 290S — Survivor's Benefit: Choosing Income Tax Withholding Preferences

Form 290S establishes your federal and North Carolina state tax withholding elections for survivor pension payments. You can change these elections later, but the initial form must be filed before RSD issues the first payment.

Form 336 — Guaranteed Refund Beneficiary Designation

Form 336 names the person who receives the Guaranteed Refund — the remaining balance of the retiree's accumulated contributions if total pension payments received were less than the contributions plus interest at retirement. The Guaranteed Refund beneficiary cannot be the same person as the monthly survivor beneficiary under Options 2, 3, 6-2, or 6-3.

This form was filed by the retiree (at retirement or any time afterward). The family does not file a new Form 336; RSD checks the one on record.

Form 333 / Form 333BEN — Contributory Death Benefit Enrollment

Form 333 is the enrollment form for the optional $10,000 Contributory Death Benefit for retired members. Like Form 336, this was filed by the retiree within 60 days of their retirement date. If the retiree enrolled, Form 333BEN designates who receives the $10,000 payout.

Documents You Must Provide

Beyond the forms, RSD requires:

• Certified death certificate — must bear the official Register of Deeds seal. A funeral home copy or a hospital record is not sufficient. A certified copy from a North Carolina Register of Deeds costs $10 under state law. Ask each recipient whether it requires a certified original before ordering more copies.

• Government-issued photo ID — your driver's license or passport for identity verification.

• Marriage license — if you are claiming as a surviving spouse (especially for Option 2/3 continuances where the retiree named the spouse as monthly survivor beneficiary).

• Court qualification papers — Letters Testamentary or Letters of Administration from the Clerk of Superior Court if you are claiming as an estate representative rather than a named beneficiary.

Where to Submit

Mail completed forms and documents to:

Retirement Systems Division, Department of State Treasurer 3200 Atlantic Avenue, Raleigh, NC 27604

Fax: (919) 855-5800

The NC TSERS Survivor Benefits Guide includes a pre-filled document inventory checklist that maps every form to the right situation — active member death versus retiree death — so nothing gets missed during the claim process.

See more North Carolina guides →