INSTRUCTIONS:Use this form to change or correct your date of birth, gender, 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 email an electronically signed Adobe PDF file to ERSC@mcpsmd.org
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 update your address, as needed, by visiting Hub+, logging in as a retiree, and selecting the Personal Information tile under the Me tab. If you do not have access to a computer, you may use this form to update your address and other personal information.
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 through Hub+. To access the online form, log in to Hub+ as a retiree, and select the Direct Deposit & W-4 tile.
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