Mass Mutual Forms

The following fillable forms are provided for your convenience. 

Beneficiary Designation Form

Benefit Election at Age 70-1/2
Election Booklet
Enrollment Forms
Important:  Forms are not fillable.  County must receive a copy of:
   a)enrollment form
   b)acknowledgement and disclosure statement form
   c)beneficiary designation in order to enroll participants in the plan. 

Note that forms are included in this Enrollment Form booklet (after cover letter).  Enrollment Forms for Mass Mutual can be mailed to:
    Contra Costa County
    Employee Benefits Service Unit
    651 Pine Street, 5th Floor
    Martinez, CA  94553

or fax to (925) 335-1798

Hardship Withdrawal:  Submit forms directly to Mass Mutual.  Do not send to Employee Benefits Service Unit

Loan Application : Application must be submitted in person to the Employee Benefits Service Unit for authorization

Notification of Change Form
: Use this form to increase or decrease your current contribution amount

Participant Change Form:  Use this form for name changes, correction to Social Security Number, Marital Status Change

Rollover forms should be sent directly to Mass Mutual.  FAX to (816) 701-8005 or e-mail to