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Employee and Retiree Service Center → Employees → Retirement planning → MCPS core and supplemental plan application forms

MCPS Core and Supplemental Plan
Retirement Application Forms

Retirement Forms Packet*

MCPS Core Plan Forms Packet
MCPS Core Plan Sample Forms Packet

Individual Retirement Forms

Members of the MCPS core and supplemental plan will need to download and complete the following forms:  

MCPS Form 455-2: Application for Retirement

MCPS Form 455-5: Designation of Beneficiary
Aetna Form GP 82519: Aetna Electronic Funds Transfer Authorization (Direct Deposit)  

MCPS Form 455-22: Retiree Benefit Plan Enrollment  

MCPS Form 480-4: Notice of Termination/Retirement  

MCPS Form 281-50: MCPS Employees' Retirement/Pension System Federal and Maryland State Withholding Request 

Additional Related Forms and Information

MCPS Form 445-1: Change in Personal Information

MCPS Form 455-26: Application for Lump Sum (De minimis) Retirement Distribution

MCPS Leave Payout Contribution
403(b) Leave Payout Form

MCPS Leave Payout Contribution
457(b) Leave Payout Form

Leave Payout Frequently Asked Questions

Employee/Covered Dependent Enrollment in Medicare Part B

Out-of-State Income Tax Withholding Form

Submit all forms to ERSC at least one month prior to your scheduled retirement.

Additional Resources

Understanding Your Retirement (PDF)
This booklet will guide you through the retirement process and assist you in understanding your retirement benefit.

Back to Retirement Planning    

*includes all individual retirement forms in one easy-to-print document
 

Montgomery County Public Schools

Contact MCPS

Call: 301-309-6277 | Spanish Hotline: 301-230-3073
E-mail: ASKMCPS@mcpsmd.org

Contact Employee & Retiree Services Center

Call: 301-517-8100 | E-mail: ersc@mcpsmd.org

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