Tier 4 Disability Retirement Kit
Download the entire kit for all Tier 4 disability forms and brochures, or download each document individually under the tabs.
Included in this kit
Use this application if you are a Tier 4 member and wish to collect a retirement benefit due to disability.
This form must be filed along with your application for disability retirement benefit.
This form contains your physician’s medical report and your authorization to provide information to NYCERS’ Medical Board.
This form authorizes NYCERS to obtain medical information pertaining to those filing for disability.
This application is to accompany your application for Disability Retirement.
This form contains detailed instructions for filing your disability retirement kit. Please review them carefully before submitting your application.
The disability retirement process for Tier 3 and 4 members.
This brochure describes the earnings limitations that service and disability retirees may be subject to if they decide to return to public service within New York City or New York State.
Use this form to authorize the New York City Employees’ Retirement System (NYCERS) to provide information and/or records to someone other than the NYCERS member, pensioner, or beneficiary.
Designation of Beneficiary – Post-Retirement Lump-Sum Death Benefit – Tier 2, Tier 4, and Tier 6
Use this form to name a beneficiary to receive a one-time lump-sum benefit upon your death after retirement (Tier 2, Tier 4, and Tier 6 only).