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Change in Personal Information for MCPS Retirees and Former Employees

About this Form

Form number: 445-1B

Audience:  MCPS Retirees

Last revised: November 2019

INSTRUCTIONS: Please type or print. Use this form to change or correct your name, title, date of birth, address, and/or Social Security number (only after receipt of your new official Social Security card). Complete this form, sign, and return it to the Employee and Retiree Service Center (ERSC). You may fax the form to 301-279-3642/301-279-3651 or e-mail an electronically signed Adobe PDF file to ERSC@mcpsmd.org.

NOTES

  1. You must complete ALL sections in the first box.
  2. You must go (in person) to your local Social Security Administration Office to complete the required form to change your Social Security records. Requested name changes will only be processed as they appear on your Social Security card.
  3. You will need to contact Aetna and the Maryland State Retirement Agency directly to update your address with these organizations.
  4. If you are an MCPS retiree who is working in a substitute or temporary assignment, you must visit the Employee Self-Service (ESS) web page and click on My address change to update your address with MCPS for payroll purposes.
  5. If you are an MCPS retiree who is working in a substitute or temporary assignment, you must complete a new W-4 if you change marital status and/or number of exemptions for income tax withholding purposes. All W-4 changes are made online. To access the online form, visit the ESS web page and click on My W-4 under the green My Pay banner. Log in using your MCPS username and password and follow the on-screen instructions. After submitting your changes, you will receive an e-mail confirmation.
Adobe PDF Change in Personal Information for MCPS Retirees and Former Employees465 KEnglish

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