Agency Forms


Agency Forms

This section contains forms that are to be filled out and submitted by your agency.

Form 623

WTC Agency Report
Form #623

This form is to be completed by the agency whose employee (or former employee) has filed a Notice of Participation with NYCERS indicating that he/she participated in WTC Rescue, Recovery or Clean-Up Operations during certain qualifying periods between September 11, 2001 and September 12, 2002.


Agency-to-Agency Transfer Notification
Form #233

This form is to be completed by any agency to notify NYCERS when a new employee who is ALREADY a NYCERS member has transferred from (1) any NYC agency; (2) NYC Transit or MTA Bridges and Tunnels; (3) any facility of the NYC Health and Hospitals Corporation; or (4) any campus of the City University of New York.