All Forms (MSRB)

All current MSRB forms are posted on this page and several have been recently updated, including the New Member Enrollment Forms below. Please be sure to always use the most current form available to ensure that all necessary information is submitted.

Important Notes About the Massachusetts State Retirement Board (MSRB) Forms:

• All current Retirement Board forms are posted on this page, and several have been recently updated, including the New Member Enrollment Forms below. Please be sure to always use the most current form available to ensure that all necessary information is submitted.
• Most of the forms below are now fillable. We strongly recommend that you fill the forms out on your computer where available before printing them. Adobe Acrobat Reader is required to view and fill out these forms. Get a free download at adobe.com.
• The forms will open up in a new window. Please be sure to close the window when you have finished filling out your form.

Are You Looking for a Group Insurance Commission (GIC) Form? They are a Separate Agency; See Below for Their Contact Information.

All Health, Dental, Vision and Life Insurance matters for retirees and their survivors are administered by the Massachusetts Group Insurance Commission (GIC). If you have questions about your health, dental, vision or life insurance coverage, or need a GIC Form, please contact the GIC at:

1. Phone: [phone] ext. 2

2. GIC Website: www.mass.gov/gic

3. GIC Contact Form: Contact the GIC Online Request Form

MSRB Retirement Application & Other Forms

Please note: these forms are specifically for members of the MA State Employees' Retirement System.

Direct Deposit of your monthly benefit payment is now required for all applications received after January 1, 2010. The required form is included with the retirement application below. If you are currently on direct deposit as an active employee, we can use the same account you are currently using. Please complete your retirement application on your computer before printing it out and mailing to us.

• Pension Benefit Estimate Request Form (MSERS)
• APPLICATION FOR RETIREMENT (MSRB) MSERS members must complete this form and submit it to the MA State Retirement Board to initiate their retirement process.
• Termination Retirement Allowance Employer's Certification (MSRB) for eligible employees hired prior to 4/2/2012 only. This form is now required for all Section 10 Termination Allowance retirements and it should be completed by the Employer.
• Judicial Retirement Application (MSRB)
• Group Classification Application (MSRB) Please note: Employees seeking Group 2, Group 4 and/or 20/50 classification approval must fill out this form.
• MSERS Retirement Advance Request Form
• MSERS Retirement Benefit Guide

MSRB Disability Retirement Forms

Please note: these forms are specifically for members of the MA State Employees' Retirement System.

• Guide to Disability Retirement (for MA Public Employees)
• Notice of Injury (MSRB) 
• Application Cover Sheet (MSRB) - print out and use as a checklist to ensure your application is complete.
• Medical Records Certification (MSRB) - to be filled out and signed by the member. Must accompany the disability application.
• Disability Application (MSRB) - Download from the Public Employee Retirement Administration Commission (PERAC) website.
• Physician's Statement Form (MSRB) - Download from the Public Employee Retirement Administration Commission (PERAC) website.

MSRB Buyback Forms

Please note: these forms are specifically for members of the MA State Employees' Retirement System.

• Purchase of Creditable Service (Buyback) Form (MSRB)
• Contract Buy Back (MSRB) 
• Creditable Service for Commissioned Officers of the USPHS Corps or NOAA Corps Buyback Form
• Veteran’s Creditable Service Purchase (Buyback) Form (MSRB)
• Section 105 Return to Active Service Form - This form is to be used by a retiree of the Massachusetts State Employees’ Retirement System (“MSERS”) to request reinstatement in a retirement system.

MSRB Refund/Rollover Request Form

Please note: this form is specifically for members of the MA State Employees' Retirement System who have left state service.

• Request for Return of Accumulated Deductions (Refund/Rollover Request) (MSRB) 

MSRB Beneficiary Forms

Please note: these forms are specifically for members of the MA State Employees' Retirement System.

• Beneficiary Change Form (MSRB) (not valid for Option C retirees)
  For complete instructions on how to complete this form, please watch our "Primary vs Contingent Beneficiaries Explained" video.
• Option D Form for ACTIVE Members (MSRB)

MSRB Retiree & Survivor Forms

Please note: these forms are specifically for members of the MA State Employees' Retirement System.

• Address Change Form (MSRB) Use this form to change or add an address to your information on file with the MSRB.
• Change of Direct Deposit for Retirement Benefit Form (MSRB) Use this form to change your bank or routing number etc. on file with the MSRB. Please mail your completed, signed form to our office. We need original signatures, so we do not accept emailed, scanned or faxed copies.
• W-4P Federal Tax Withholding Form (MSRB) Use this form to change your current Federal Tax Withholding amounts.

If you need further assistance, please send an email to: [e-mail]

MSRB Survivor Forms

Please note: these forms are specifically for members of the MA State Employees' Retirement System.

• Accidental Death Form (MSRB)
• Application for Annuity (MSRB) 
• MA Public Safety Employees Line of Duty Death Benefit Under M.G.L. c.32, §100A Form (MSRB)

MSRB Employer Forms

Please note: these forms are specifically for members of the MA State Employees' Retirement System.

Please choose ONE "New Member" form, 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
  The above form is for new Commonwealth (state) employees only. All applicable sections must be filled out.
  For complete instructions on how to complete this form, please watch our "How to Fill Out the Commonwealth Agency New Member Enrollment Form" video. 
   
• NON-Commonwealth Agency New Member Enrollment Form (MSRB)
  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.
• Section 10 Employer Certification Form (MSRB)
  This form is now required for all Section 10 Termination Allowance retirements
• Service Transfer Form (MSRB) 
• Notice of Injury Form (MSRB) 
  If the employee was injured while on the job, please document the incident with this form.

MSRB Pension Estimate Percentage Charts

Please note: these Retirement Estimate Percentage Charts are specifically for members of the MA State Employees' Retirement System.

Members can calculate their own retirement benefit estimate by using the appropriate Retirement Estimate Percentage Chart below. 

Click here if you were hired PRIOR TO April 2, 2012 (MSRB)

Click here if you were hired AFTER April 2, 2012 (MSRB)

STATE POLICE OFFICERS — Group 3 Retirement Percentage Chart

MSERS Retirement Benefit Guide

Please note: The MSERS Retirement Benefit Guide is specifically for members of the Massachusetts State Employees' Retirement System.

Additional Resources

MSERS Retirement Benefit Guide