|
# |
Tier(s) |
Form/Brochure Name |
PDF Download |
| |
| MEMBERSHIP
FORMS |
| 101 |
1,2 |
Application for
Membership for Tier 1 and Tier 2 Members |
Download Now |
| 103 |
3,4,6 |
Application for Membership for
NYCERS-Eligible Employees
|
Download Now |
| 181 |
ALL |
Membership / Tier
Reinstatement |
Download Now |
| 212 |
1,2 |
Increased-Take-Home-Pay
(ITHP) Waiver/Cancellation |
Download Now |
| 311 |
1,2 |
Application to
Cancel Rate of Deduction |
Download Now |
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|
| MEMBERSHIP
BROCHURES |
| 968 |
ALL |
New Member Kit |
Download Now |
| 967 |
ALL |
PIN Brochure |
Download Now |
| 905 |
ALL |
Membership
Reinstatement |
Download Now |
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|
| PHYSICALLY TAXING TITLES Fact Sheet |
| 712 |
4 |
Physically Taxing Titles |
Download Now |
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|
| SPECIAL
PLAN FORMS |
| |
| 161 |
3 |
Election of 20-Year Retirement Program – Tier 3 NYC
Correction Members of the Rank of Captain or Above |
Download Now |
| 162 |
1,2 |
Election of Career
Pension Plan or ISF - Tier 1 and Tier 2 Members |
Download Now |
| 165 |
2,3 |
Election of 20-Year
Retirement Program -Tier 2 and Tier 3 NYC Correction Members Below the Rank of Captain |
Download Now |
| 166 |
2,3 |
Election of 20-Year Retirement Program – Tier 2 or Tier 3 NYC
Correction Members of the Rank of Captain or Above |
Download Now |
| 169 |
1,2,4 |
Election of
Optional Dispatcher 25-Year Retirement Program |
Download Now |
| 170 |
1,2,4 |
Election of Optional
EMT 25-Year Retirement program |
Download Now |
| 175 |
2,4 |
Election of 20-year
Sanitation Retirement Program |
Download Now |
| 183 |
2,4 |
25-Year/Age 50 Plan
Election Form - Automotive Service Titles - Tiers 2 and 4 |
Download Now |
| 184 |
2, 4 |
25-Year Plan
Election Form - Deputy Sheriffs - Tiers 2 and 4 |
Download Now |
| 185 |
1,2,4 |
25-Year Plan
Election Form - Special Officer Titles - Tiers 1, 2 and 4 |
Download Now |
| 189 |
2,4 |
25 Year Plan
Election Form - (911) Police Communications Titles |
Download Now |
| 192 |
2 |
Election of the
Optional 20-Year Retirement Program For Tier 2 Investigator Members |
Download Now |
| 193 |
2 |
Election of the
Optional 25-Year Retirement Program For Tier 2 Investigator Members |
Download Now |
| 219 |
1,2 |
Election of
Coverage Under the Transit Non-Contributory 20-Year Retirement Plan |
Download Now |
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|
| SPECIAL
PLAN BROCHURES |
| 910 |
4 |
Transit 25-55 Tier 4 |
Download Now |
| 914 |
2 |
The Automotive
Service Worker 25-Year and Age 50 Retirement Program (50/25) - For Tier 2
Members |
Download Now |
| 916 |
2 |
Special Officer
25-Year Retirement Program - For Tier 2 Members |
Download Now |
| 917 |
3 |
Correction Force 20-Year Retirement Plan |
Download Now |
| 918 |
3 |
Correction Officer 20-Year Retirement Plan |
Download Now |
| 920 |
3 |
Correction Officer 25-Year Retirement Plan |
Download Now |
| 932 |
4 |
The Automotive
Service Worker 25-Year and Age 50 Retirement Program (50/25) - For Tier 4
Members |
Download Now |
| 933 |
4 |
Deputy Sheriff
25-Year Retirement Program - For Tier 4 Members |
Download Now |
| 934 |
4 |
Special Officer
25-Year Retirement Program - For Tier 4 Members |
Download Now |
| 935 |
4 |
Sanitation 20-Year
Retirement Program |
Download Now |
| 936 |
4 |
EMT 25-Year
Retirement Plan - Tier 4 |
Download Now |
| 937 |
4 |
Dispatcher 25-Year
Plan For Tier 4 Members |
Download Now |
| 938 |
4 |
MTA Bridges and
Tunnels 20-Year, Age 50 Plan For Tier 4 Members |
Download Now |
| 940 |
2 |
911 COMMUNICATIONS
OPERATORS/25 YEAR PLAN For Tier 2 Members |
Download Now |
| 941 |
4 |
911 COMMUNICATIONS
OPERATORS/25 YEAR PLAN For Tier 4 Members |
Download Now |
| 942 |
2 |
D.A.
INVESTIGATORS/20 YEAR PLAN For Tier 2 Members |
Download Now |
| 943 |
2 |
D.A.
INVESTIGATORS/25 YEAR PLAN For Tier 2 Members |
Download Now |
| 944 |
4 |
55/25 Retirement Plan
For Tier 4 Members |
Download Now |
| 945 |
4 |
57/5 Retirement Plan
For Tier 4 Members |
Download Now |
| 946 |
4 |
62/5 Retirement Plan for Tier 4 Members |
Download Now |
| 985 |
6 |
Triborough Bridge and Tunnel Authority 20-Year/Age 50 Retirement Plan for Tier 6 Members |
Download Now |
| 986 |
6 |
Transit Operating Force 25-Year/Age 55 Retirement Plan for Tier 6 Members |
Download Now |
| 987 |
6 |
Emergency Medical Technician 25-Year Retirement Plan for Tier 6 Members |
Download Now |
| 988 |
6 |
Dispatcher 25-Year Retirement Plan for Tier 6 Members |
Download Now |
| 989 |
6 |
Deputy Sheriff 25-Year Retirement Plan for Tier 6 Members |
Download Now |
| 990 |
6 |
Special Peace Officer 25-Year Retirement Plan for Tier 6 Members |
Download Now |
| 991 |
6 |
Automotive Member 25-Year/Age 50 Retirement Plan for Tier 6 Members |
Download Now |
| 992 |
6 |
Police Communications Technician 25-Year Retirement Plan for Tier 6 Members |
Download Now |
| 993 |
6 |
63/10 Retirement Plan for Tier 6 Members (Tier 6 Basic Plan) |
Download Now |
| 994 |
6 |
Uniformed Correction Force 22-Year Plan for Tier 6 Members |
Download Now |
| 995 |
6 |
Uniformed Sanitation Force 22-Year Plan for Tier 6 Members |
Download Now |
| 996 |
6 |
DA Investigators 22-Year Plan for Tier 6 Members |
Download Now |
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|
| BENEFICIARIES
FORMS |
| 131 |
1,2 |
Designation of
Beneficiaries for Tier 1 and Tier 2 Members |
Download Now |
| 133 |
3,4,6 |
Designation of Beneficiary for Tier 3,
4, and 6 Members
|
Download Now |
| 134 |
3,4,6 |
Designation of Primary and Contingent
Beneficiary for Tier 3, 4, and 6 Members
|
Download Now |
| 136 |
ALL |
Supplemental
Designation of Beneficiaries |
Download Now |
| 137 |
ALL |
Designation of
Guardian- When Designating a Minor as a Beneficiary |
Download Now |
| 366 |
1 |
Selection by
Designated Beneficary of Benefits Under Option One Payable as an Annuity Under
Option A |
Download Now |
| 367 |
1 |
Selection by Designated Beneficiary of Benefits Under
Option One Payable as an Annuity Under Option B |
Download Now |
| 383 |
ALL |
Accidental Death Affidavit |
Download Now |
| 501 |
2,4 |
Designation of
Beneficiary - Post Retirement Lump-Sum Death Benefit |
Download Now |
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|
| SPECIAL
PLAN OPT OUT FORMS |
| 176 |
4,6 |
Opt Out Election
Form- EMT Members Only >>>
25 Year Retirement Program for Tier 4 and 6 |
Download Now |
| 177 |
4,6 |
Opt Out Election
Form- Dispatcher Members Only -
25 Year Retirement Program for Tier 4 and 6 |
Download Now |
| 186 |
4,6 |
Opt Out Election
Form - Special Officer Titles 25 Year Retirement Program for Tier 4 and 6 |
Download Now |
| 190 |
4,6 |
Opt Out Form -
Police Communications Titles >>>
25 Year Retirement Program for Tier 4 and 6 |
Download Now |
| 220 |
1,2 |
Withdrawal From
Transit 20-Year Retirement Plan For Tier 1 and Tier 2 Members and Election of
the Age Fifty Five One Percent Plan |
Download Now |
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|
| TRANSFERRING
FORMS |
| |
| 232 |
ALL |
Transferred Contributor Affidavit - City University
of New York (CUNY) Employees (ONLY for CUNY members who received a
letter from
NYCERS and who wish to remain NYCERS members as
transferred
contributors)
|
Download Now |
| 321 |
ALL |
Application for
Transfer of Member's Accumulated Salary Deductions to Another Retirement System
Within New York State |
Download
Now |
| 324 |
1,2 |
Election to Transfer Membership for Retirees of NYCERS |
Download Now |
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|
| BUY-BACK
FORMS |
| |
| 237 |
ALL |
Request to Adjust Payment for the Purchase of Pre-Member
or Military Service
|
Download Now |
| 238 |
ALL |
Request to Cancel Application For The Purchase
of Pre-Member or Military Service |
Download Now |
| 239 |
ALL |
Request to Cancel Current Pre-Member or Military
Service Payroll Deductions |
Download Now |
| 240 |
ALL |
Request For a Lump-Sum Payoff Balance For The
Purchase of Pre-Member or Military Service |
Download Now |
| 241 |
ALL |
Application to
Purchase Credit for Service Rendered Prior to Membership Date in NYCERS |
Download Now |
| 242 |
ALL |
Departmental
Certificate of Status of Member Claiming Service Prior to Membership Date
Full-time Service Only |
Download Now |
| 243 |
ALL |
Dept Certificate of
Service Rendered by Member Claiming Previous Part-time Service Prior to Mem
Date in NYCERS for Part-time Service Only |
Download Now |
| 245 |
ALL |
Application to
Purchase Service Credit for Layoff Time
Department of Sanitation Uniformed Force |
Download Now |
| 246 |
1,2,3 |
Application to
Purchase Service for Child Care Leave for Correction Members |
Download Now |
| 247 |
ALL |
Agency Verification |
Download Now |
| 248 |
ALL |
Application to
Purchase Service for Layoff Time |
Download Now |
| 249 |
ALL |
Application to
Purchase Service Credit for Layoff Time for Carpenters & Supervisory
Carpenters |
Download Now |
| 250 |
ALL |
Application to
Purchase Service Credit for Layoff Time for NYC Parks Department Climbers and
Pruners |
Download Now |
| 252 |
ALL |
Application to Purchase Service Credit for Layoff Time for Employees of the School Construction Authority |
Download Now |
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|
| BUY-BACK
BROCHURES |
| 901 |
ALL |
Buy-Back Brochure
Purchasing Credit For Service Rendered Prior to NYCERS Membership |
Download Now |
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|
| MILITARY
BUY-BACK FORMS |
| 244 |
ALL |
Application to
Purchase Credit for Military Service |
Download Now |
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|
| MILITARY
BUY-BACK BROCHURES |
| 902 |
ALL |
Buy-Back Brochure
Purchasing Military Credit |
Download Now |
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|
| LOAN
FORMS |
| 301 |
1,2 |
Application for Loan
(Tier 1 and Tier 2 Members Only) |
Download Now |
| 302 |
3,4 |
Application for Loan
(Tier 3 and Tier 4 Members Only) |
Download Now |
| 303 |
1,2 |
Application for Loan
Against Additional Member Contributions (AMCs) |
Download Now |
| 305 |
ALL |
Authorization to
Release NYCERS Loan Information (to accompany
Deferred Comp Loan Application) |
Download Now |
| 309 |
3,4 |
Application for
Change in Loan Repayment Schedule |
Download Now |
| 310 |
3,4 |
Request for Change to Recent Loan Application
|
Download Now |
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|
| LOAN
BROCHURES |
| 912 |
1,2 |
Loans Brochure (Tier
1 and Tier 2) |
Download Now |
| 911 |
3,4 |
Loans Brochure (Tier
3 and Tier 4) |
Download Now |
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|
| LOAN
FACT SHEETS |
| 706 |
ALL |
Loan IRS Fact Sheet |
Download Now |
| 710 |
ALL |
Loan Default Fact Sheet |
Download Now |
| 714 |
3,4 |
Loan Reduction Factors |
Download Now |
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|
| REFUND
FORMS |
| 331 |
ALL |
Application for
Refund of Member's Accumulated Salary Deductions |
Download Now |
| 332 |
1,2 |
Application for
Refund of Excess Contributions |
Download Now |
| 333 |
ALL |
Application for
Refund of Additional Member Contributions |
Download Now |
| 336 |
ALL |
Application for Refund of Additional Member Contributions
For Transit 25 Year/Age 55 Members |
Download Now |
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|
| REFUND
BROCHURES |
| 913 |
ALL |
Refunds |
Download Now |
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|
| VESTING
FORMS |
| 251 |
1,2 |
Notice of Intention
to File an Application for a Vested Retirement Benefit |
Download Now |
| 254 |
3,4 |
Notice of Intention
to File an Application for Payment of a Tier 3 or Tier 4 Deferred Vested
Retirement Benefit |
Download Now |
| 255 |
2 |
Application for Payment of a Reduced Vested Retirement Benefit |
Download Now |
| 261 |
1,2 |
Application for
Payment of a Vested Retirement Benefit Tier 1 and 2 Members (Except Corrections
and Sanitation) |
Download Now |
| 263 |
1,2 |
Application for
Deferred Vested Retirement Allowance Tier 1 and Tier 2 Members of the Uniformed
Force of the NYC Department of Correction Who Discontinue Service Other Than By
Death, Retirement or Dismissal |
Download Now |
| 265 |
4 |
Application for
Payment of Vested Retirement Benefit Tier 4 Members with Tier 3 Rights |
Download Now |
| 266 |
4 |
Application for
Payment of a Tier 4 Deferred Vested Retirement Benefit |
Download Now |
| 269 |
1,2 |
Application for
Deferred Vested Retirement Allowance Tier 1 and Tier 2 Members of the Uniformed
Force of the NYC Department of Sanitation Who Discontinue Service Other Than By
Death, Retirement or Dismissal |
Download Now |
| 283 |
3,4 |
Affidavit for
Payment of a Vested Retirement Benefit |
Download Now |
| 341 |
ALL |
Waiver of Right to a
Vested Retirement Benefit |
Download Now |
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|
| VESTING
BROCHURES |
| 903 |
1,2 |
Vesting Tier 1 &
Tier 2 |
Download Now |
| 904 |
3,4 |
Vesting Tier 3 &
Tier 4 |
Download Now |
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|
| LEAVING CITY SERVICE BROCHURE |
| 908 |
4 |
Leaving City Service (for Tier 4 members in the 62/5, 55/25 and 57/5 plans) |
Download Now |
| POWER OF ATTORNEY |
| 203 |
ALL |
Affidavit That Power of Attorney is in Full Force |
Download Now |
| 204 |
ALL |
Special Durable Power of Attorney |
Download Now |
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|
| SERVICE
RETIREMENT FORMS |
| 511 |
1 |
Application for
Service Retirement for Tier 1 |
Download Now |
| 512 |
1 |
Application for
Service Retirement for Tier 1 Members of the NYC Transit Authority |
Download Now |
| 521 |
2,3,4 |
Application for
Service Retirement for Tiers 2,3, and 4 Members |
Download Now |
| 542 |
ALL |
Withdrawal
of Service Retirement Application |
Download Now |
| 543 |
ALL |
Request
to Change or Correct Retirement Date |
Download Now |
| 544 |
ALL |
Revision
Form |
Download Now |
| 595 |
1 |
Application for
Without Fault or Delinquency Retirement |
Download Now |
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|
| SERVICE
RETIREMENT BROCHURES |
| 931 |
ALL |
Retirement
Application Process |
Download Now |
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|
| RETIREMENT
OPTIONS FORMS |
| 550 |
1 |
Retirement Option
4-4 Tier 1 Members |
Download Now |
| 551 |
1 |
Retirement Option Election Form for Tier 1 (Option 1, Option 4 – Lump Sum).
|
Download Now |
| 552 |
1,2 |
Retirement Option
Election Form For Tier 1 and Tier 2 (Maximum, Option 2, Option 3, Option4-2,Option 4-3) |
Download Now |
| 553 |
2 |
Retirement Option
Election for Tier 2 (Option 4) |
Download Now |
| 554 |
2,3,4 |
Retirement Option
Election Form for Tier 2, Tier 3, and Tier 4 (5-Year and 10-Year Certain) |
Download Now |
| 555 |
3 |
Retirement Option
Election Form for Tier 3 (Maximum, Option 1, 2, 5) |
Download Now |
| 556 |
4 |
Retirement Option
Election Form for Tier 4 (Maximum, Option 1, 2, and 5) |
Download Now |
| 557 |
1 |
Retirement Option 4 for Tier 1 Members |
Download Now |
| 558 |
2 |
Retirement Option 4-4 for Tier 2 Members |
Download Now |
| 559 |
2 |
Retirement Option 4 for Tier 2 Members |
Download Now |
| 560 |
2 |
Selection by
Beneficiary(ies) of a Tier 2 Member to Annuitize the Ordinary Death Benefit |
Download Now |
| 561 |
1 |
Retirement Option Election Form for Tier 1 - Option 4 (Five-Year Certain; Ten-Year Certain) |
Download Now |
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|
| RETIREMENT
OPTIONS BROCHURES |
| 923 |
1 |
Options Brochure For
Tier 1 Members |
Download Now |
| 924 |
2 |
Options Brochure For
Tier 2 Members |
Download Now |
| 925 |
3 |
Options Brochure For
Tier 3 Members |
Download Now |
| 926 |
4 |
Options Brochure For
Tier 4 Members |
Download Now |
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|
| DISABILITY
FORMS |
| 601 |
1 |
Application for
Disability Retirement Tier 1 Members |
Download Now |
| 602 |
2 |
Application for
DisabiIity Retirement Tier 2 Members |
Download Now |
| 603 |
3 |
Application for
Disability Retirement Tier 3 Uniformed Correction Force Only |
Download
Now |
| 604 |
4 |
Application for
Disability Retirement Tier 4 Members |
Download Now |
| 605 |
ALL |
Applicant's Report
of Personal Disability |
Download Now |
| 606 |
ALL |
Physician's Report
of Disability |
Download Now |
| 607 |
ALL |
Agency Report on
Accident |
Download Now |
| 608 |
ALL |
General
Authorization for Medical Information |
Download Now |
| 609 |
ALL |
Questionnaire
Applicants for Disability Retirement |
Download Now |
| 611 |
3,4 |
Affidavit Electing
to Process Disability Retirement |
Download Now |
| 613 |
ALL |
Final Medical Review
Waiver (To be completed by the Member) |
Download Now |
| 614 |
ALL |
Waiver Pursuant to
the Provisions of Article 14 of the Retirement and Social Security Law (RSSL)
as it Pertains to Disability Retirements |
Download Now |
| 618 |
ALL |
Consent of
Disability Retiree to Report Personal Service Income* Each Year |
Download Now |
| 619 |
ALL |
Withdrawal of
Disability Retirement Application |
Download Now |
| 622 |
ALL |
WTC Notice of
Participation |
Download Now |
| 623 |
ALL |
WTC Agency Report |
Download Now |
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|
| DISABILITY
BROCHURES |
| 921 |
1,2 |
Disability
Retirement For Tier 1 & Tier 2 |
Download Now |
| 922 |
3,4 |
Disability
Retirement For Tier 3 & Tier 4 |
Download Now |
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|
| DISABILITY
FACT SHEETS |
| 703 |
ALL |
WTC Disability Law
Fact Sheet |
Download Now |
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|
| PROCESSING
DEATH BENEFITS |
| 702 |
ALL |
Processing
Death Benefits |
Download Now |
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|
BIRTH EVIDENCE |
| 709 |
ALL |
Birth Evidence Alternatives |
Download Now |
| 205 |
ALL |
Birth Evidence Affidavit |
Download Now |
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|
| PENSIONER
SPECIFIC FORMS |
| 349 |
ALL |
Application to
Change Federal Income Tax Withheld |
Download Now |
| 350 |
1,2 |
Safeguards Information Affidavit |
Download Now |
| 351 |
3,4 |
Affidavit of
Personal Service Income |
Download Now |
| 352 |
ALL |
Election by a Retiree Reentering City Service to Rejoin NYCERS |
Download Now |
| 353 |
ALL |
Certificate of
Employment Under Section 212 of the Retirement and Social Security Law (RSSL) |
Download Now |
| 354 |
ALL |
Affidavit of Workers' Compensation Payments |
Download Now |
| 355 |
ALL |
Payroll Verification Affidavit |
Download Now |
| 380 |
ALL |
Authorization for
Direct Deposit (EFT) of Monthly Retirement Allowance |
Download Now |
| 382 |
ALL |
Report of Beneficiary's Death - Pop-Up
Option Elected |
Download Now |
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|
PENSIONER
SPECIFIC BROCHURES |
| 958 |
ALL |
Earning Limitations For Service Retirees and Disability Retirees |
Download
Now |
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|
| GUIDE TO YOUR PENSION
CHECK |
| 705 |
ALL |
Guide to Your Pension
Check |
Download Now |
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|
| PENSION PAYMENT SCHEDULE |
| 713 |
ALL |
Pension Payment Schedule
|
Download Now |
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|
| REQUEST
INFORMATION FORMS |
| 852 |
ALL |
Request for
Information |
Download Now |
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|
| CALCULATING
FINAL AVERAGE SALARY BROCHURES |
| 928 |
2 |
How To Calculate
Your Final Average Salary Tier 2 |
Download Now |
| 929 |
4 |
How To Calculate
Your Final Average Salary Tier 4 |
Download Now |
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|
| CALCULATING
RETIREMENT BENEFIT BROCHURES |
| 927 |
4 |
Calculating Your
Retirement Benefit For Participants in Tier 4 General Membership (62/5, 57/5,
55/25) |
Download Now |
| 930 |
4 |
Calculating Your
Retirement Benefit For Tier 4 Transit 25-55 Members |
Download Now |
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|
| LOST
CHECK FORMS |
| 399 |
ALL |
Affidavit Concerning
Lost Check |
Download Now |
| ADDRESS
CHANGE FORMS |
| 290 |
ALL |
Change of Address |
Download Now |
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|
| NAME
CHANGE FORMS |
| 291 |
ALL |
Name Change
Affidavit |
Download Now |
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|
