Form #355
NYCERS periodically requests completion of this form by certain retirees to verify your account and ensure that you are receiving your benefits.

4 Things You Need to Know About the Payroll Verification Affidavit

It helps NYCERS verify your account. Things change all the time, the Payroll Verification Affidavit is NYCERS’ way of ensuring that your benefits are getting to you!
Not everyone will receive Form #355 but, if you do, you must complete it, have it notarized, and submit it to NYCERS to avoid suspension of your pension check and possibly your health insurance. If NYCERS cannot verify your account, your pension check will be suspended, which may impact your health insurance.
If you don’t complete Form #355 within the timeframe specified, NYCERS will send a reminder via mail to the address on file. If you are a registered MyNYCERS user, you’ll also receive an alert in your online account.
The easiest (and quickest!) way to complete Form #355 is to do so online via your secure MyNYCERS account. You may also submit Form #355 by mail to NYCERS at 30-30 47th Avenue, Suite 1010, Long Island City, NY 11101.

Important Information for Powers of Attorney (POAs)

If You Already Have a Power of Attorney on File at NYCERS

If your Attorney-in-Fact has powers to complete NYCERS’ transactions and you would like your Attorney-in-Fact to complete Form #355 on your behalf, please submit a copy of the POA to NYCERS along with Form #355.
If your POA does not allow your Attorney-in-Fact to complete NYCERS’ transactions and you would like to name someone as your Attorney-in-Fact for NYCERS’ purposes only, you may submit Form #204 – Special Durable Power of Attorney (POA). Refer to Fact Sheet #745 – How to Complete Form #204 – Power of Attorney for instructions to help you complete the form.

Remember, Form #355 will be deemed invalid if it is not completed correctly, not notarized, or if it is completed on your behalf by a third party and there is no valid POA on file with NYCERS.

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