Employee and Retiree Service Center → Employees → Retirement planning → State core and MCPS supplemental plan application forms
Members of the State core plan and MCPS supplemental plan will need to print and complete the following forms:
SRA Form 13-23: Application for Service or Disability Retirement SRA Form 4: Designation of BeneficiarySRA Form 766: Federal and Maryland State Tax Withholding SRA Form 85: Electronic Funds Transfer (Direct Deposit) Sign-Up SRA Form 127: Reemployment After Retirement
In addition, members of the State core plan will need to download and complete the following forms to receive their MCPS supplemental plan benefit:
MCPS Form 455-2: Application for Retirement MCPS Form 455-5: Designation of BeneficiaryAetna Direct Deposit formMCPS Form 455-22: Retiree Benefit Plan Enrollment MCPS Form 480-4: Notice of Termination/Retirement
MCPS Form 445-1: Change in Personal Information
MCPS Form 455-26: Application for Lump Sum (De minimis) Retirement DistributionMCPS Leave Payout Contribution403(b) Leave Payout FormMCPS 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.
Understanding Your Retirement (PDF)This booklet will guide you through the retirement process and assist you in understanding your retirement benefit.
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