Tier 3

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.

Form 562

Temporary Retirement Option Election Form – Tier 2, 3, 4 and 6
Form #562

This form is for members in Tier 2, 3, 4 and 6 who have filed an application for Service or Disability Retirement or Payment of a Vested Retirement Benefit, or whose agency has filed a Disability Retirement Application on their behalf. This form allows you to elect one of two temporary options before you elect a permanent option and thereby make a final decision regarding the way in which your retirement benefit will be paid. NYCERS recommends that you choose a temporary option as soon as possible.

Form 554

Retirement Option Election Form – Tier 2, Tier 3, and 22-Year Plan – Five-Year and Ten-Year Certain
Form #554

This Retirement Option Election Form allows you to elect the Five-Year Certain or Ten-Year Certain Option. By electing this option, you will receive a reduced retirement benefit. If you die within five (or ten) years from the date of retirement, the reduced monthly benefit will continue to be paid to the designated primary beneficiary for the unexpired balance of the five- (or ten-) year period. 

Form 543

Request to Change or Correct Retirement Date
Form #543

If you previously filed a Service Retirement Application with NYCERS, you may change your retirement date by filing this form with NYCERS up to the day before your effective retirement date. If your request is received on or after your retirement date, it is denied.

Note: You cannot change your retirement date if you are already receiving your pension from NYCERS.

Form 341

Waiver of Right to a Vested Retirement Benefit
Form #341

For members who have at least five but less than ten years of Credited Service and wish to terminate their membership by withdrawing their accumulated member contributions. Note: By filing this form and withdrawing your contributions, you will waive your right to a Vested Retirement Benefit.