Tier 2
Application to Purchase Service Credit for Layoff Time – NYC Parks Department Climbers and Pruners
Form #250
For NYC Parks Department employees in the titles of Climber and Pruner who wish to purchase service for the time they were laid off for economic reasons on or after July 1, 1991 and returned to active service no later than July 1, 1995.
Application to Purchase Service Credit for Layoff Time – Carpenters and Supervisory Carpenters
Form #249
For NYC Carpenters and Supervisory Carpenters who wish to purchase service for the time they were laid off for economic reasons on or after June 1, 1991 and returned to service prior to July 1, 1993.
Application to Purchase Service for Layoff Time – Correction Members
Form #248
For Department of Correction members who wish to purchase service for the time the member was laid off for economic reasons.
Agency Verification – Corrections Child Care Leave
Form #247
This application is to be completed by the agency of the NYCERS Tier 1, Tier 2 or Tier 3 Corrections member who has applied to purchase previous child care leave.
Application to Purchase Service for Child Care Leave – Tier 1, Tier 2, Tier 3 Correction Members
Form #246
For Tier 1, Tier 2 and Tier 3 Correction members who wish to purchase service for time spent on child care leave.
Application to Purchase Service Credit for Layoff Time – Department of Sanitation Uniformed Force
Form #245
For Department of Sanitation Uniformed Force members who wish to purchase service for the time the member was laid off.
Departmental Certificate of Status of Member Claiming Service Prior to Membership Date
Form #242
In order to process a buy-back application, NYCERS must verify the salary and service history for the period of time the member wants to purchase. This form is to be completed by the agency the member worked for to provide verification of the member’s salary and service. It is not acceptable without the documentation listed on the form.
Application to Purchase Credit for Service Rendered Prior to Membership Date in NYCERS (Buyback)
Form #241
Use this application to purchase (buyback) previous full-time or part-time public service rendered within New York State prior to your NYCERS membership. Note: Tier 1 members may only buy back public service rendered in a NYCERS-eligible title.
Request for a Lump-Sum Payoff Balance for the Purchase of Pre-Member or Military Service
Form #240
For members who are currently paying for pre-member and/or military service through payroll deductions and want an estimate of their lump-sum payoff balance.
Request to Cancel Current Pre-Member or Military Service Payroll Deductions
Form #239
For members who are currently paying for pre-member and/or military service through payroll deductions and wish to cancel their purchase.
Request to Cancel Application for the Purchase of Pre-Member or Military Service
Form #238
For members who applied to purchase pre-member and/or military service and wish to cancel their application before payroll deductions begin.
Request to Adjust Payment for the Purchase of Pre-Member or Military Service
Form #237
For members who are purchasing pre-member service and wish to adjust the amount of payment.
Election to Transfer Membership for Retirees of NYCERS
Form #324
For Tier 1 and Tier 2 Retirees who wish to transfer their membership to the New York State and Local Retirement System (NYSLRS) or the New York City Teachers Retirement System (NYCTRS).
Withdrawal from Transit 20-Year Retirement Plan for Tier 1 and Tier 2 Members and Election of the Age 55 One-Percent Plan
Form #220
For Tier 1 and Tier 2 members who wish to withdraw from the Transit 20-Year Retirement Plan. If you choose to no longer participate in this plan, you will automatically be placed in the Age 55 One-Percent Plan within your Tier.
Designation of Beneficiary – Post-Retirement Lump-Sum Death Benefit – Tier 2, Tier 4, and Tier 6
Form #501 is temporarily unavailable.
To make changes to your beneficiaries or their designated guardians, log in to your MyNYCERS account and look for “Manage Beneficiaries” in the menu.
If you are new to MyNYCERS, register for immediate access. Need help?
Accidental Death Affidavit
Form #383
This affidavit is for the spouse of a deceased NYCERS member who is receiving an accidental death benefit and is required to attest to his/her marital status each year.
Designation of Guardian – When Designating a Minor as a Beneficiary
Form #137 is temporarily unavailable.
To make changes to your beneficiaries or their designated guardians, log in to your MyNYCERS account and look for “Manage Beneficiaries” in the menu.
If you are new to MyNYCERS, register for immediate access. Need help?
Supplemental Designation of Beneficiaries
Form #136 is temporarily unavailable.
To make changes to your beneficiaries or their designated guardians, log in to your MyNYCERS account and look for “Manage Beneficiaries” in the menu.
If you are new to MyNYCERS, register for immediate access. Need help?
Designation of Beneficiary(ies) – Tier 1 and Tier 2
Form #131 is temporarily unavailable.
To make changes to your beneficiaries or their designated guardians, log in to your MyNYCERS account and look for “Manage Beneficiaries” in the menu.
If you are new to MyNYCERS, register for immediate access. Need help?
DA Investigators 25-Year Plan for Tier 2 Members
Brochure #943
This brochure describes the benefits of the D.A. Investigators 25-Year Plan which is available ONLY to members employed in District Attorney’s Offices and joined NYCERS in an Investigator title between July 1, 1973 and March 31, 2012.