New Enrollment Form
All applicable sections must be filled out.
Change of Beneficiary Form
Please ensure that the most recent form is used, social security number is required for all beneficiary forms.
Social Security Administration Form SSA-1945 (This link takes you to a website outside of Mass.gov)
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.
Group Classification Form
Employees in Groups 2 and 4 must fill out this form.
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.
Section 10 Employer Certification Form file size 1MB
This form is now required for all Section 10 retirements.
Notice of Injury Form
If the employee was injured while on the job, please document the incident with this form.