FORMS REQUISITION
FORM # REVISION DATE REQUESTED QUANTITY ISSUED FORM DESCRIPTION DATE OF REQUEST
001 004 005 009 010 013-023 014-024 020 021A 022 026 028 037 041 043 046 060 085 097 098-101 100 127 128 129 131 143 504 505 632 756 757 766
12/08 12/08 08/08 12/08 12/08 12/08 12/08 11/08 12/08 07/08 11/07 11/99 06/00 12/08 06/08 12/04 04/07 11/05 12/08 12/08 10/05 07/08 07/08 11/08 07/08 05/07 07/08 04/03 11/08 07/08 04/03 03/09 06/08 05/09 05/09 07/04 07/05
Application for Membership Designation of Beneficiary Application for Withdrawal of Accumulated Contributions (packet of material) Application for an Estimate of Service Retirement Allowance Application for an Estimate of Service Retirement Allowance - State Police Application for Service or Disability Retirement Application for Service or Disability Retirement - State Police Statement of Disability Application for an Estimate of Disability Retirement Allowances Application for an Estimate of Disability Retirement Allowances - State Police Request to Purchase Previous Service Request of Certification of Annual Salary Election to Transfer Service Forms Requisition Form Claim of Retirement Credit for Military Service Application to be placed on a Qualifying Approved Leave of Absence Election not to participate in TPS "Join Alternative Retire Plan" Direct Deposit - Electronic Fund Transfer Application for an Estimate of Service Retirement Allowances (LEOPS) Application for Service or Disability Retirement (LEOPS) Application for an Estimate of Disability Retirement Allowances (LEOPS) Re-employment & Retirement (for Teachers’ and Employees’, and Correctional Officers’ System) Re-employment and Retirement (for State Police Retirement System) Preliminary Application for Disability Retirement Re-employment after Retirement (for Law Enforcement Officers’ Pension System) Verification of Retiree’s Disabled Child for Selection of Option 2/5 Beneficiary Application for DROP (LEOPS) Application for DROP Withdrawal (LEOPS) Authorization for Release of Medical Records by Employing Agency Application for DROP (State Police) Application for DROP Withdrawal (State Police) Federal and Maryland Tax Withholding Form Pamphlet “Welcome to the Employees’ & Teachers’ Pension System” Pamphlet “Welcome to the Law Enforcement Officers’ Pension System” Pamphlet “Welcome to the Correctional Officers’ Retirement System” Benefits Handbook for STATE POLICE Retirement System Benefits Handbook for Employees’ and Teachers’ RETIREMENT System STATE RETIREMENT AGENCY 120 EAST BALTIMORE STREET BALTIMORE, MARYLAND 21202-6700 ATTENTION: OFFICE SERVICES DIVISION FAX# 410-468-1700
ORDER A QUANTITY OF FORMS NEEDED FOR THE NEXT SIX MONTHS: ADDRESS YOUR ORDER TO:
PLEASE DON’T OVER ORDER DELIVER TO: Agency Name Address City
Many of these forms can be printed from the State Retirement Agency’s Internet Web site:
www.sra.state.md.us
ORDERED BY: Name Phone Number State Zip Code
(Please Print)
LOCATION CODE: FORM #041 (Rev. 6/09)
(MUST HAVE TO FILL ORDERS)