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Form #ProductNameAudiencemyMERS
MD-802
IRA
Contribution Form
All, Participant, Retiree
Yes
MD-073
Defined Contribution, Hybrid Plan
Contribution Addendum for MERS DC (and DC portion of Hybrid)
Employer
No
DB-021b
Defined Benefit
Spouse Waiver Consent
All, Participant
No
MD-005b
457 Program, Defined Contribution, Hybrid Plan, IRA
Direct Rollover Between MERS Plans
Participant, Retiree
No
MD-807
IRA
Non-Spousal Beneficiary Claim Request Form
Employee, Participant, Retiree
No
IRA
Application
Participant, Retiree
Yes
F-05
Defined Benefit
Enrollment Kit
Employer, Participant
No
DB-013a
Defined Benefit
Benefit Change - Permanent or Temporary
All, Employer
No
DB-013b
Defined Benefit, Defined Contribution, Hybrid Plan
Projection Study
Employer
No
F-17
Defined Benefit
Employee Census
Employer
No
F-21
Defined Benefit
Beneficiary Change
Participant
Yes
MD-069
Defined Contribution
Adoption Resolution
Employer
No
MD-069b
Defined Contribution
Admin Order Adopting MERS Defined Contribution Plan
Employer
No
MD-070
Defined Contribution
Adoption Agreement
Employer
No
MD-071
Defined Contribution
MERS Loan Addendum
Employer
No
F-24
Defined Benefit
Refund Application
Participant
No
F-26
Defined Benefit
Refund Application for Deceased Member's Contributions
Participant
No
F-29
Defined Benefit
Application for Retirement
Participant
Yes
F-29c
Defined Benefit, Defined Contribution, Hybrid Plan
Working in Retirement Certification
Participant
No
F-31
Defined Benefit, Hybrid Plan
Pension Federal Income Tax
Participant, Retiree
Yes
F-31b
Defined Benefit, Defined Contribution, Hybrid Plan
Withholding for Pension or Annuity Payments
Participant
Yes
F-32
Defined Benefit, Hybrid Plan
Monthly Pension Beneficiary Application
Participant
No
F-35b
Defined Benefit
Participant Transfer Certification for Same Employer
Participant
No
F-36
Defined Benefit, Hybrid Plan
Funds Transfer – Direct Deposit Authorization
Participant, Retiree
Yes
F-37
Defined Benefit
Stop Payment
Participant
No
F-38
Defined Benefit
Qualified Fund Rollover to MERS
Participant
No
F-41
Defined Benefit, Hybrid Plan
Beneficiary Change for Period Certain Payments
Participant, Retiree
No
F-42
Defined Benefit
DROP+ and Election
Participant
No
F-48
Defined Benefit
Alternate Payee (Former Spouse) Benefit Application
Participant
No
F-51
Defined Benefit
Application for Disability Retirement
Employer, Participant
No
F-52
Defined Benefit
Disability Retirement
Participant
No
F-53
Defined Benefit
Physician's Statement of Disability
Employer, Participant
No
F-54
Defined Benefit
Psychiatric Medical Report
Employer, Participant
No
F-71
Defined Benefit
Model DRO
Participant
No
F-72
Defined Benefit
Model EDRO
Participant
No
F-75
Defined Contribution
Model DRO
Participant
No
F-79
Defined Benefit, Defined Contribution, Hybrid Plan
Reciprocal Units (Act 88) - Resolution
Employer
No
MD-000
Defined Contribution
Enrollment Kit
Employer, Participant
No
MD-001
457 Program, Defined Benefit, Defined Contribution, Health Care Savings Program, Hybrid Plan
Personal Information
Participant
Yes
MD-102
Health Care Savings Program
Investment Change
Participant
Yes
MD-002
Defined Contribution
Investment Change
Participant
Yes
MD-703
457 Program, Defined Contribution, Defined Contribution Plus
Beneficiary Designation
Participant
No
MD-004
Defined Contribution
Incoming Rollover
Participant
No
MD-006
Defined Contribution
Spousal Beneficiary Claim
Participant
No
MD-007
Defined Contribution
Non-Spousal Beneficiary Claim
Participant
No
MD-009
Defined Contribution
Required Minimum Distribution
Participant
No
MD-010
Defined Contribution
Loan Application
Participant
No
MD-016
Defined Contribution
MERS-to-MERS Service Verification
Participant
No
MD-369
Hybrid Plan
Adoption Resolution
Employer
No
MD-369b
Hybrid Plan
Admin Order Adopting MERS Hybrid
Employer
No
MD-370
Hybrid Plan
Adoption Agreement
Employer
No
MD-371
Hybrid Plan
Loan Addendum
Employer
No
MD-103
Health Care Savings Program
Beneficiary Designation
Participant
Yes
MD-303
Hybrid Plan
Beneficiary Designation
Participant
Yes
MD-304
Hybrid Plan
Incoming Direct Rollover
Participant
No
MD-400
457 Program
Enrollment Kit
Employer, Participant
No
MD-402
457 Program
Investment Change
Participant
Yes
MD-404
457 Program
Incoming Transfer
Participant
No
MD-406
457 Program
Spousal Beneficiary Claim
Participant
Yes
MD-407
457 Program
Non-Spousal Beneficiary Claim
Participant
No
MD-409
457 Program
Required Minimum Distribution
Participant
No
MD-410
457 Program
Loan Application
Participant
No
MD-412
457 Program
Unforeseeable Emergency Withdrawals
Participant
True
MD-413
457 Program
457 In-Plan Roth Conversion
Participant
No
MD-414
457 Program
Contribution Catch Up
Participant
No
MD-415
457 Program
Opt Out Refund
Participant
No
MD-469
457 Program
Uniform Resolution
Employer
No
MD-471
457 Program
Loan Addendum
Employer
No
MD-470
457 Program
Participation Agreement
Employer
No
MD-473
457 Program
Contribution Addendum for 457
Employer
No
MD-474
457 Program
Eligible Automatic Contribution Arrangement (EACA) Addendum
Employer
No
2160
Group Life & Disability Insurance
Proposal Process & Data Checklist
Employer
No
2527
Stable Income Annuity
Request for Absolute Assignment / Successor Owner Endorsement
Participant
No
8513
Stable Income Annuity
Adoption Packet
Participant
No
12999
Stable Income Annuity
Disclosure
Participant
No
6146
Stable Income Annuity
Statement of Beneficiary Claim to Benefits
Participant
No
6304
Stable Income Annuity
Beneficiary
Participant
No
6614
Stable Income Annuity
Request for Contract Application Amendment
Participant
No
11436
Stable Income Annuity
Request for Change of EFT Annuity Payout
Participant
No
12428
Stable Income Annuity
Request for Change to Annuity Policy
Participant
No
13018
Stable Income Annuity
Qualified Joint and Survivor Annuity Notice / Spousal Consent
Participant
No
MD-300
Hybrid Plan
Enrollment Kit
Employer, Participant
No
MD-100
Health Care Savings Program
Enrollment Kit
Employer, Participant
No
MD-169
Health Care Savings Program
Uniform Resolution
Employer
No
MD-170
Health Care Savings Program
Participation Agreement
Employer
No
RH-669
Retiree Health Funding Vehicle
Uniform Resolution
Employer
No
None
Group Life & Disability Insurance
Life Insurance Enrollment / Change
Employer
No
None
Group Life & Disability Insurance
Medical History Statement (Evidence of Insurability)
Employer
No
None
Group Life & Disability Insurance
Application for Group Insurance Over 25 Employees
Employer
No
None
Group Life & Disability Insurance
Application for Group Insurance with Under 25 Employees
Employer
No
None
Group Life & Disability Insurance
Life Insurance Benefits Claim Packet
Employer
No
None
Group Life & Disability Insurance
Accelerated Benefit Claim Packet
Employer
No
None
Group Life & Disability Insurance
Waiver of Premium Claim Packet
Employer
No
None
Group Life & Disability Insurance
Life Insurance Portability
Employer
No
None
Group Life & Disability Insurance
Request for Life Conversion Materials
Employer
No
None
Group Life & Disability Insurance
Disability Claim Packet
Employer
No
None
Group Life & Disability Insurance
Accidental Dismemberment Claim Packet
Employer
No
DB-001a
Defined Benefit
Admin Order Adopting The MERS Defined Benefit Plan
Employer
No
DB-001b
Defined Benefit
Resolution Adopting The MERS Defined Benefit Plan
Employer
No
DB-002
Defined Benefit
Adoption Agreement
Employer
No
FN-003
457 Program, Defined Contribution, Health Care Savings Program, Hybrid Plan, Investment Services Program, Retiree Health Funding Vehicle
ACH Debit Request - Automated Transfer Authorization
Employer
No
MD-505
Investment Services Program
Distribution
Employer
No
F-73
457 Program
Model DRO
Participant
No
MD-302
Hybrid Plan
Investment Change
Participant
Yes
DB-004
Defined Benefit
Service Credit Purchase Opt-Out Form
Employer
No
DB-007
Defined Benefit
Defined Benefit Plan Surplus Division Adoption Addendum
Employer
No
DB-094
Defined Benefit
Employer Resolution Establishing Uniform Transfer Provision
Employer
No
MD-700
Defined Contribution Plus
Enrollment Kit
Employer, Participant
No
F-27
Defined Benefit, Defined Contribution, Hybrid Plan
Other Governmental Service Application
Participant
No
F-74
Hybrid Plan
Model EDRO
Participant
No
F-55
Defined Benefit
Application for Defined Benefit Deferred Retirement Option Program (DROP)
Participant
No
F-56
Defined Benefit
Defined Benefit DROP Distribution Request Form
Participant
No
MD-105
Health Care Savings Program
Reimbursement Claim Form
Participant, Retiree
Yes
DB-001c
457 Program, Defined Benefit, Defined Contribution, Health Care Savings Program, Hybrid Plan, Investment Services Program, Retiree Health Funding Vehicle
Resolution Establishing Authorized Signatories for MERS Contracts and Service Credit Purchase Approvals
Employer
No
MD-803
IRA
Beneficiary Information
Participant
No
MD-809
IRA
IRA Required Minimum Distribution Request Form
Participant
No
MD-802a
IRA
IRA Investment Change Form
Participant
Yes
Defined Benefit
DB Plan Invoice Change Request
Employer
Yes