An Important Note About Forms:

Most MSRB retirement forms have been recently updated, including the New Member Enrollment Forms below. Please be sure to always give your employees the most current form available to ensure that all necessary information is submitted. If you're not sure if you have the most current form, please visit our Frequently Requested Forms or All Forms & Publications web page.

New Member Enrollment Forms

Choose ONE, either the "Commonwealth" OR "NON-Commonwealth" version. Also, please ask employees if they have prior service that can be transferred so that their contribution rate is calculated accurately. 

Commonwealth Agency New Member Enrollment Form pdf format of Commonwealth Agency New Member Enrollment Form 
file size 1MB
The above form is for new Commonwealth (state) employees only. All applicable sections must be filled out.

NON-Commonwealth Agency New Member Enrollment Form pdf format of NON-Commonwealth Agency New Member Enrollment Form
The above form is for new non-Commonwealth employees who are eligible to participate in the State Employees Retirement System.  These include non-teaching staff of educational collaboratives and certain regional vocational high schools; and employees of other participating non-Commonwealth entities.

Click here for a list of MSERS NON-Commonwealth Employers pdf format of list of MSERS NON-Commonwealth Employers
.

Beneficiary Selection/Change Form

Change of Beneficiary Form pdf format of Change of Beneficiary Form
 
Please ensure that the most recent form is used, social security number is required for all beneficiary forms.

Group Classification Request Form

Group Classification Form  pdf format of Questionnaire
Employees in Groups 2 and 4 must fill out this form, usually within six months of their retirement date.

Instructions: A Group Classification Questionnaire must be submitted for each position for which a member is seeking Group Classification. The member must first complete Section A and submit the application and all attachments to the human resources department at the agency which employed them in the position for which they seek group classification. The agency must then complete Section B and submit the application and all attachments to the Board. The complete application must be reviewed by the member’s direct supervisor or the current supervisor familiar with the duties of the position being reviewed.

Option D Form

Please advise employees that Option D is an option for current employees (active members) only. Once an employee retires, Option D becomes invalid. For more information, visit our Option D web page.

Notice of Injury Form

Notice of Injury Form  pdf format of notice_of_injury.pdf
 
If the employee was injured while on the job, please document the incident with this form.

§10(2)Termination Retirement Allowance Form

Section 10 Employer Certification Form pdf format of Section 10 Employer Certification Form
file size 1MB 
Important note: This form is now required for all Section 10 retirements. G.L. c. 32, § 10(2) provides for a Termination Retirement Allowance to any member of a Retirement System who became a member prior to April 2, 2012, and has at least twenty years of creditable service and who fails of reappointment, or whose office or position is abolished, or who is removed or discharged from his or her office or position without moral turpitude.

Social Security SSA-1945 Form

Social Security Administration Form SSA-1945  pdf format of Social Security Administration Form SSA-1945
All new employees must fill out this form and it should be filed with their employee record as it acknowledges that they have been made aware that they do not pay into social security as members of the Massachusetts State Employees' Retirement System.

Background: The Social Security Protection Act of 2004 (Public Law 108-203) requires state and local employers who hire individuals for non-Social Security covered positions on or after January 1, 2005 to provide these new hires with Form SSA-1945. This notice explains the possible reduction in the employee’s future Social Security benefit as a result of the Windfall Elimination Provision and Government Pension Offset. The new hire must sign the notice, acknowledging that he or she is aware of this possible reduction.

If the form you need is not listed on this page, please visit our Forms and Publications web page or please contact us.