Employee and Retiree Service Center → Employees → Retirement planning → MCPS core and supplemental plan application forms
MCPS Core Plan Forms Packet
MCPS Core Plan Sample Forms Packet
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 455-22R, Retiree Benefit Plan Enrollment for New Retirees
MCPS Form 480-4, Notice of Termination/Retirement
MCPS Form 281-50, MCPS Employees' Retirement/Pension System Maryland State Withholding Request
IRS Form W-4P: Withholding Certificate for Periodic Pension or Annuity Payments
MCPS Form 445-1B, Change in Personal Information
MCPS Form 455-26, Application for Lump Sum (De minimis) Retirement Distribution
MCPS Form 455-28, 403(b) Leave Payout Contribution Agreement
MCPS Form 455-29, 457(b) Leave Payout Contribution Agreement
MCPS Form 455-4, Request for Refund of MCPS Prepaid Benefits
IRS Form W-4R: Withholding Certificate for Nonperiodic Payments and Eligible Rollover Distributions
Leave Payout Frequently Asked Questions
Employee/Covered Dependent Enrollment in Medicare Part B (If you are enrolled in Medicare Part A contact your local Social Security Office before you enroll online)
Social Security Administrative offices are currently closed. The link below provides instructions to enroll online in Medicare Part B
https://www.ssa.gov/pubs/EN-05-10531.pdf
Once you apply for Medicare part B, please visit www.Medicare.gov, register and create a username and password. This will allow you to track the progress of Medicare Part B application at Social Security and provide you with access to the PDF version of your Medicare Part B card. Please email the pdf version of your Medicare Part B card to the ERSCmailbox(ersc@mcpsmd.org)
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.