|
# |
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 |
Application for
Membership for Tier 3 and Tier 4 Members |
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 |
|
ALL |
New Member Kit
|
Download
Now |
|
ALL |
Pin Brochure
|
Download
Now |
| 905 |
ALL |
Membership
Reinstatement
|
Download
Now |
| 907 |
ALL |
Membership
Information For Newly Hired Employees of the City of New York
|
Download
Now |
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|
| SPECIAL
PLAN ELECTION FORMS |
| |
| 161 |
3 |
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 Members |
Download
Now |
| 166 |
2,3 |
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 |
| 187 |
2,4 |
Re-opener of 25 Year/Age 50 Plan Election Form - Automotive
Service Titles - Tiers 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 |
ALL |
Election of
Coverage Under the Transit Non-Contributory |
Download
Now |
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|
| SPECIAL
PLAN ELECTION 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 Plan For Tier 3 Only
|
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 |
ALL |
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 |
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|
| BENEFICIARIES
FORMS |
| 131 |
1,2 |
Designation of
Beneficiaries for Tier 1 and Tier 2 Members |
Download
Now |
| 133 |
3,4 |
Designation of
Beneficiary for Tier 3 Correction Officer and Tier 4 Members Only |
Download
Now |
| 134 |
3,4 |
Designation of
Primary and Contingent Beneficiary for Tier 3 Correction Officer and Tier 4
Members Only |
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 |
| 501 |
ALL |
Designation of
Beneficary - Post Retirement Lump-Sum Death Benefit |
Download
Now |
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|
| SPECIAL
PLAN OPT OUT FORMS |
| 176 |
4 |
Opt Out Election
Form- EMT Members Only >>>
25 Year Retirement Program for Tier 4
|
Download
Now |
| 177 |
4 |
Opt Out Election
Form- Dispatcher Members Only
25 Year Retirement Program for Tier 4
|
Download
Now |
| 186 |
4 |
Opt Out Election
Form - Special Officer Titles 25 Year Retirement Program for Tier 4 |
Download
Now |
| 190 |
4 |
Opt Out Form -
Police Communications Titles >>>
25 Year Retirement Program for Tier 4 |
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 |
| |
| 321 |
ALL |
Application for
Transfer of Member's Accumulated Salary Deductions to Another Retirement System
Within New York State |
Download
Now |
| 323 |
ALL |
Application For
Transfer of Membership To The Police Pension Fund |
Download
Now |
| 324 |
ALL |
Election To Transfer
Membership To NYCTRS or NYSLERS |
Download
Now |
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|
| BUY-BACK
FORMS |
| |
| 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 |
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 |
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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
Eligible members can now take out loans at Deferred Comp. In order to do so,
you must download and submit a
Deferred Comp Loan Application along with form #305.
|
Download
Now |
| 309 |
3,4 |
Application for
Change in Loan Repayment Schedule |
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 |
|
ALL |
Loan IRS Fact Sheet |
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 |
| 361 |
ALL |
Benefit Claimed
Under §1310 of the Surrogate's Court Procedure Act
|
Download
Now |
| 362 |
ALL |
Benefit Claimed
Under §1310 of the Surrogate's Court Procedure Act for Funeral Expenses
|
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 |
| 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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|
| SERVICE
RETIREMENT FORMS |
| 255 |
2 |
Election of Early
Service Retirement |
Download
Now |
| 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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|
| SERVICE
RETIREMENT (415) FACT SHEETS |
|
ALL |
415 Fact Sheet |
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 |
| 558 |
2 |
Retirement Option 4-4 |
Download
Now |
| 559 |
2 |
Retirement Option 4 |
Download
Now |
| 560 |
2 |
Selection by
Beneficiary(ies) of a Tier 2 Member to Annuitize the Ordinary Death Benefit |
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 |
|
ALL |
WTC Disability Law
Fact Sheet |
Download
Now |
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|
| PENSIONER
SPECIFIC FORMS |
| 203 |
ALL |
Affidavit That Power of Attorney is in Full Force |
Download
Now |
| 349 |
ALL |
Application to
Change Federal Income Tax Withheld |
Download
Now |
| 351 |
3,4 |
Affidavit of
Personal Service Income |
Download
Now |
| 352 |
ALL |
Pensioner Reentering
City Service |
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 For Accidental Disability Retirees |
Download
Now |
| 380 |
ALL |
Authorization for
Direct Deposit (EFT) of Monthly Retirement Allowance |
Download
Now |
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|
| PENSIONER
SPECIFIC FACT SHEETS |
|
ALL |
Pension Check Fact
Sheet |
Download
Now |
|
ALL |
Earning Limitations For Service Retirees and Disability Retirees |
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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|
