Forms

Messaging for Customers

To protect the health of our members and employees, Retirement System consultation offices are closed until further notice. To schedule a phone consultation, and for all other inquiries, contact us at 1-866-805-0990; 518-474-7736 in the Albany, NY area. However, we strongly encourage you to use Retirement Online to do business with NYSLRS at this time.

COVID-19 Information: To understand your NYSLRS benefits if you are impacted by COVID-19, and the steps to take if you become seriously ill, visit our COVID-19 Help Center.


Member Forms


If you are retired, please go to the Retiree and Beneficiary Forms section.

Retirement Online now offers more services and time-saving features. In many cases, noted below, you can use Retirement Online instead of sending forms through the mail or calling NYSLRS. Because Retirement Online is a secure website, you may certify and submit your applications electronically instead of mailing in a notarized paper form.

 


Beneficiary Changes

Consider using Retirement Online to add or remove beneficiaries, or to update your beneficiary’s contact information.

 

Designation of Beneficiary

To change your beneficiary information. Learn more about beneficiary changes.

(RS5127, Rev. 12/18)

 

Designation of Beneficiary — Trust

To designate a trust as either your primary or contingent beneficiary. This form is for active members only. If you are retired and receiving a pension (and have retired under payment option ½, 1, 5-Year Certain or 10-Year Certain), you should use the Pensioner’s Designation of Beneficiary form (RS6439).

(RS5127-T, Rev. 9/18)

 


Contact Information Changes

Consider using Retirement Online to update your contact information and to choose to receive correspondence from NYSLRS by email.

 

Change of Address Form

To change your address. Learn more about address changes.

(RS5512, Rev. 10/18)

 

Name Change Notice

To change your name (for active members only). Retirees should contact us to change their name.

(RS5483, Rev. 10/18)

 


Membership and Contributions

Consider using Retirement Online to reinstate an earlier tier of membership, transfer your membership, or withdraw from NYSLRS.

 

Tier Reinstatement Application

To reinstate a former membership in a public retirement system in New York State.

(RS5506, Rev. 10/18)

 

Transfer Membership Within NYSLRS

The Employees’ Retirement System (ERS) and Police and Fire Retirement System (PFRS) are the two separate systems that comprise NYSLRS.

Use this form to transfer a membership between these two retirement systems. Certain eligibility requirements apply. If you have questions, contact us before applying online or submitting the form.

(RS5535, Rev. 6/19)

 

Transfer Membership to Public Retirement System Outside of NYSLRS

To transfer your current NYSLRS membership out of ERS or PFRS, to another public retirement system in New York State. Certain eligibility requirements apply. If you have questions, contact us before applying online or submitting the form.

(RS5534, Rev. 9/18)

 

Transfer Back to ERS from PFRS

To reverse a transfer you previously made from ERS to PFRS. If eligible, this type of transfer will move all ERS salary, service and contributions that were formerly transferred to PFRS back to an ERS membership. Certain eligibility requirements apply. If you have questions, contact us before applying online or submitting the form. To qualify for this transfer, you must be currently covered by Section 384-d, 384-e or 381-b of the Retirement & Social Security Law (RSSL).

(PF5467, Rev. 12/09)

 

Withdrawal Application

To withdraw your NYSLRS membership. If you have questions, contact us before applying online or submitting the form.

(RS5014, Rev. 11/18)

 

Election to Make Voluntary Contributions

For Tier 1 & 2 members (and Tier 3, 5 & 6 PFRS members who are non-contributory) who want to begin making voluntary contributions to NYSLRS for an annuity at retirement.

(RS5379, Rev. 9/18)

 

Cancellation of Election to Make Voluntary Contributions

For Tier 1 & 2 members (and Tier 3, 5 & 6 PFRS members who are non-contributory) who want to discontinue making voluntary contributions to NYSLRS.

(RS5378, Rev. 9/18)

 

Refund of Excess Contributions

For Tier 1 & 2 members (and Tier 3, 5 & 6 Police and Fire Retirement System (PFRS) members who are non-contributory) who voluntarily contribute to NYSLRS and want a refund of their member contributions prior to retirement.

(RS5195, Rev. 11/18)

 


Member Death Benefits

 

Notification of Death

Your survivors or employer should contact us to notify the Retirement System of your death so benefits can be paid to your beneficiary(ies), if applicable.

(RS6082, Rev. 10/18)

 

Survivor’s Benefit Program Beneficiary Application

To apply for the benefits payable on behalf of a deceased NYSLRS member as part of the Survivor’s Benefit Program.

(RS6356, Rev. 10/18)

 

Application for Direct Trustee to Trustee Transfer (Taxable)

To request the direct transfer of a deceased NYSLRS member or retiree’s death benefit to a beneficiary’s qualified plan. Use this form when the benefit amount is not reportable for federal income tax purposes.

(RS5531, Rev. 11/18)

 

Application for Direct Trustee to Trustee Transfer (Non-Taxable Amount Only)

To request the direct transfer of a deceased NYSLRS member or retiree’s death benefit to a beneficiary’s qualified plan. Use this form when the benefit amount is not reportable for federal income tax purposes.

(RS5531-N, Rev. 11/18)

 

Non-member Employee Designation of Beneficiary for Eligible Employees of a New York State Agency

Due to eligibility requirements, this form is not available from our website. You must contact us to order a copy.

(RS6357)

 

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Loans

Consider using Retirement Online to find out how much you can borrow, apply for a loan with NYSLRS and check the status of your application. You can also use Retirement Online to manage your loan payments, including increasing your payroll deductions and submitting a payment online.

Note: the following loan forms only apply to NYSLRS members. If you are a member of another public retirement system, please visit that system’s website for the appropriate forms.

 

Tiers 1 & 2 Loan Application

For all Tier 1 and 2 members (ERS and PFRS) who have annuity savings member contributions on deposit with NYSLRS. Please make sure you read all pages and sign where necessary on page 3. We do not accept faxed loan applications.

Note: Please make sure this form prints properly with all text showing — especially in the Notary area — or the form may be rejected.

(RS5025, Rev. 2/19)

 

Tiers 3, 4, 5 & 6 Loan Application

For Tier 3, 4, 5 & 6 members (covered by Articles 14, 15 or 22). Please make sure you read all pages and sign where necessary on page 3. We do not accept faxed loan applications.

Note: Please make sure this form prints properly with all text showing — especially in the Notary area — or the form may be rejected.

(RS5025-A, Rev. 2/20)

 

Loan Payment Change Form

To change the loan payment amount that is being deducted from your earnings by your employer.

(RS5521, Rev. 2/19)

 

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Retirement — Service

Consider using Retirement Online to estimate your pension benefit and to apply for a service retirement.

 

Application for Service Retirement

This is a two-page form. Please submit both pages.

Note: During the COVID emergency, the 15 day retirement waiting period has been waived. You can choose a retirement date or enter “ASAP” and your date of retirement will be the day after your filing date. You should also submit a pension payment option election form. Both need to be notarized. Read this blog post for more info.

(RS6037, Rev. 9/18)

 

Withdrawal of Application for Service Retirement

(RS6354, Rev. 9/18)

 

Request for Estimate

This is a two-page form. Please submit both pages.

(RS6030, Rev. 4/19)

 

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Retirement — Disability

If you are terminally ill, you will want to file a payment option election form along with your disability retirement application. For more information, please read Processing Your Application in our publication, Life Changes, Applying for Disability Retirement.

 

Article 14 Disability Retirement Application

For Tier 3 Employees’ Retirement System members and Tier 3 Police and Fire Retirement System members covered by Article 14 benefits. This is a two-page form and a HIPAA waiver. Please submit all three pages.

(RS6411, Rev. 9/18)

 

Article 14-B Disability Retirement Application

For county sheriffs, undersheriffs and certain deputy sheriffs whose employers elected coverage under Sections 555, 556, 557 or 558 of the Retirement & Social Security Law (RSSL). This is a two-page form and a HIPAA waiver. Please submit all three pages.

(RS6408, Rev. 9/18)

 

Article 15 Disability Retirement Application

For Tier 3, 4, 5 and 6 members. This is a two-page form and a HIPAA waiver. Please submit all three pages.

(RS6340, Rev. 11/18)

 

605-A Accidental Disability Retirement Application

For court officers and peace officers in the Unified Court System. This is a two-page form and a HIPAA waiver. Please submit all three pages.

(RS6410, Rev. 12/18)

 

Environmental Conservation & Regional State Park Police Disability Retirement Application

For State Environmental Conservation and Regional State Park police officers covered by Section 363-e (RSSL). This is a two-page form and a HIPAA waiver. Please submit all three pages.

(PF6091, Rev. 9/18)

 

507-A Disability Retirement Application

For Tier 3, 5 and 6 NYS correction officers and security hospital treatment assistants. This is a two-page form and a HIPAA waiver. Please submit all three pages.

(RS6409, Rev. 9/18)

 

Ordinary Disability Retirement Application

For PFRS members and Tier 1 and 2 ERS members. This application is not for Tier 3 members covered under Article 14. This is a two-page form and a HIPAA waiver. Please submit all three pages.

(RS6038, Rev. 11/18)

 

Performance of Duty Disability Retirement Application

For NYS correction officers and security hospital treatment assistants who are covered by Chapters 653 and 722 (RSSL). This application is not for Tier 3 PFRS members covered under Article 14. This is a two-page form and a HIPAA waiver. Please submit all three pages.

(RS6047-A, Rev. 9/18)

 

Performance of Duty Disability Retirement Application

For sheriffs, deputy sheriffs, undersheriffs and county correction officers in counties that elected Sections 63-B, 63-C, 607C and 607D. This is a two-page form and a HIPAA waiver. Please submit all three pages.

(RS6047-B, Rev. 11/18)

 

Accidental Disability Retirement Application

For Police & Fire Retirement System members, Tier 1 and Tier 2 Employees’ Retirement System members and ERS members covered under Section 605-d and 607-e. This is a two-page form and a HIPAA waiver. Please submit all three pages.

(RS6047, Rev. 11/18)

 

Performance of Duty Disability Retirement Application for PFRS and for ERS Under Section 607-g and 89-v

Application for Police & Fire Retirement for disability incurred in the performance of duty and ERS members covered under Section 607-g and 89-v. This application is not for Tier 3 PFRS members covered under Article 14. This is a two-page form and a HIPAA waiver. Please submit all three pages.

(RS6442, Rev. 11/18)

 

State Police Disability Retirement Application

For Tier 1, 2, 5 and 6 members and officers employed by the Division of NYS Police. This is a two-page form and a HIPAA waiver. Please submit all three pages.

(PF6090, Rev. 9/18)

 

Application for World Trade Center Notice

Notice of participation for those involved in the rescue, recovery or clean up operations of the World Trade Center aftermath. The deadline for filing the WTC notice has been extended to 9/11/22.

(RS6047-N, Rev. 11/18)

 

World Trade Center Accidental Disability Presumption Application

Application for disability retirement for those involved in the rescue, recovery or clean up operations of the World Trade Center aftermath. This is a two-page form and a HIPAA waiver. Please submit all three pages.

(RS6047-W, Rev. 11/18)

 

Application for Conversion of Service or Disability Retirement to Accidental Death Benefit for Victims of the 2001 World Trade Center Disaster

For beneficiaries of World Trade Center disaster victims. A beneficiary must file this application to convert a deceased retiree’s pension benefit to an accidental death benefit.

(RS6418-W, Rev. 1/19)

 

Authorization for Release of Health Information Pursuant to HIPAA

HIPAA forms must be submitted with all disability applications.

(RS6429, Rev. 9/18)

 

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Option Election

Consider using Retirement Online to choose your pension payment option (option election) when you apply for a service retirement online.

 

Tier 1 Members who are choosing one option beneficiary

(RS6109-A, Rev. 12/04)

 

Tier 2 Members who are choosing one option beneficiary

(RS6163-A, Rev. 12/04)

 

Tier 1 Members who are choosing multiple option beneficiaries

(RS6268-A, Rev. 12/04)

 

Tier 2 Members who are choosing multiple option beneficiaries

(RS6352-A, Rev. 12/04)

 

Tier 3, 4, 5 and 6 Members who are choosing one option beneficiary

(RS6399, Rev. 12/18)

 

Tier 3, 4, 5 and 6 Members who are choosing multiple beneficiaries

(RS6400, Rev. 4/19)

 

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Option Election with Partial Lump Sum Payment

Consider using Retirement Online to choose your pension payment option (option election) when you apply for a service retirement online.

These forms are for eligible Police & Fire members, county Correction Officers, Sheriffs, Undersheriffs and Deputy Sheriffs only. Eligible members must choose whether to receive a partial lump sum payment (a percentage of their pension value) in addition to choosing an option beneficiary.

 

Tier 1 Members who are choosing one beneficiary

(RS6419-A, Rev. 8/14)

 

Tier 2, 3, 5 and 6 Members who are choosing one beneficiary

(RS6421-A, Rev. 4/19)

 

Tier 1 Members who are choosing multiple option beneficiaries

(RS6420-A, Rev. 8/14)

 

Tier 2, 3, 5 and 6 Members who are choosing multiple option beneficiaries

(RS6422-A, Rev. 4/19)

 

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Service Credit

Consider using Retirement Online to request previous or military service credit.

 

Request to Purchase Service Credit (Including any Military Service)

To request service credit for your public service before you became a member of NYSLRS, or to request credit for military service.

(RS5042, Rev. 12/18)

 

Application for Direct Trustee-to-Trustee Transfer for Purchase of Service Credit

To request the direct transfer of funds from a qualified plan in order to purchase optional service credit.

(RS2416, Rev. 12/13)

 

Change in Payroll Deductions for Service Credit Purchase

To change the service credit purchase amount that is being deducted from your earnings by your employer.

(RS5526, Rev. 2/19)

 

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Special Retirement Plans

 

20-Year Retirement Plan (Section 384-d) Election Form

For Police & Fire Retirement System (PFRS) members whose employers have adopted this plan.

(PF5117, Rev. 9/18)

 

25-Year Retirement Plan (Section 384) Election Form

For PFRS members whose employers have adopted this plan.

(PF5095, Rev. 9/18)

 

Withdrawal from 25-Year Retirement Plan (Section 384)

Allows PFRS members who elected this plan to withdraw from it after one year of coverage.

(PF5094, Rev. 10/02)

 

Withdrawal from 20-Year Retirement Plan (Section 384-d and 384-e)

Allows PFRS members who elected this plan to withdraw from it after one year of coverage.

(PF5466, Rev. 1/03)

 

Election Form for 25-Year Retirement Plan for ERS Tier 3 Members (Sections 89, 603 and 604)

To be completed only by qualified Tier 3 members who are eligible to elect coverage under a special 25-year retirement plan as defined in Sections 89, 603 and 604.

(RS5473, Rev. 9/18)

 

Election Form for Sheriffs, Undersheriffs and Deputy Sheriffs 25-Year Retirement Plan Under Article 14-B

To be completed only by sheriffs, undersheriffs, or deputy sheriffs directly engaged in criminal law enforcement 50% or more of the time, who are police officers under the criminal procedure act, and who are employed by a county which has elected to make these benefits available.

(RS5495, Rev. 1/19)

 

Election Form for Sheriffs, Undersheriffs and Deputy Sheriffs 25-Year Additional 1/60 Retirement Plan Under Article 14-B (Section 551(e))

To be completed only by sheriffs, undersheriffs, or deputy sheriffs directly engaged in criminal law enforcement 50% or more of the time, who are police officers under the criminal procedure act, and who are employed by a county which has elected to make these benefits available.

(RS5496, Rev. 9/18)

 

Election Form for Sheriffs, Undersheriffs and Deputy Sheriffs 20-Year Retirement Plan Under Article 14-B

To be completed only by sheriffs, undersheriffs, or deputy sheriffs directly engaged in criminal law enforcement 50% or more of the time, who are police officers under the criminal procedure act, and who are employed by a county which has elected to make these benefits available.

(RS5497, Rev. 1/19)

 

Election Form for Sheriffs, Undersheriffs and Deputy Sheriffs 20-Year Additional 1/60 Retirement Plan Under Article 14-B (Section 553)

To be completed only by sheriffs, undersheriffs, or deputy sheriffs directly engaged in criminal law enforcement 50% or more of the time, who are police officers under the criminal procedure act, and who are employed by a county which has elected to make these benefits available.

(RS5498, Rev. 9/18)

 

Election Form for Sheriffs, Undersheriffs and Deputy Sheriffs 20-Year Retirement Plan with Additional 1/60 Under Article 14-B (Sections 552 and 553)

To be completed only by sheriffs, undersheriffs, or deputy sheriffs directly engaged in criminal law enforcement 50% or more of the time, who are police officers under the criminal procedure act, and who are employed by a county which has elected to make these benefits available.

(RS5498-A, Rev. 1/19)

 

Election Form for Sheriffs, Undersheriffs and Deputy Sheriffs 25-Year Retirement Plan with Additional 1/60 Under Article 14-B (Sections 551 and 551(e))

To be completed only by sheriffs, undersheriffs, or deputy sheriffs directly engaged in criminal law enforcement 50% or more of the time, who are police officers under the criminal procedure act, and who are employed by a county which has elected to make these benefits available.

(RS5501, Rev. 1/19)

 

Election Form for 25-Year Retirement Plan for Tier 3, 4, 5 and 6 Security Hospital Treatment Assistants (Section 89)

To be completed only by qualified security hospital treatment assistants, security hospital senior treatment assistants, security hospital supervising treatment assistants or security hospital treatment chiefs in Tier 3, 4, 5 or 6.

Note: this form currently does not comply with the Americans with Disabilities Act (ADA). For an ADA compliant version of this form, please contact us.

(RS5475, Rev. 9/18)

 

Election Form for 25-Year Retirement Plan for Tier 3 Sheriffs, Undersheriffs, Deputy Sheriffs and Correction Officers (Section 89-p)

To be completed only by Tier 3 sheriffs, undersheriffs, deputy sheriffs and correction officers not already enrolled in a plan that permits retirement at any age after completing 25 years of service, and who are employed by a county which has elected to make these benefits available.

(RS5473-P, Rev. 5/06)

 

Election Form for Coverage Under Article 22 (Tier 5) in Accordance with Chapter 263 of the Laws of 2016

For PFRS Tier 3 members who want to elect coverage under Article 22 (Tier 5).

(RS5536, Rev. 9/18)

 

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Retiree and Beneficiary Forms

 

Contact Information Changes

You can update your contact information by using Retirement Online, our secure, self-service web application.

Change of Address Form

To change your address.

(RS5512, Rev. 10/18)

 

Name Change Notice

To change your name.

(RS5483, Rev. 10/18)

 


Death Benefits

 

Tier 2, 3, and 4 Post-Retirement Death Benefit Designation of Beneficiaries

Consider using Retirement Online to add or remove beneficiaries, or to update your beneficiary’s contact information. This paper form is to be used only for those already retired to change the beneficiary to receive their post-retirement death benefit. This form will be deemed invalid if received before your date of retirement. This beneficiary does not have to be the same as the retirement option beneficiary. This is a two-page form. Please submit both pages.

(RS4471, Rev. 9/06)

 

Pensioner’s Designation of Beneficiaries

To designate a beneficiary for when a retiree has selected a pension payment option that allows for beneficiary changes beyond the date of retirement (for example, the five- or ten-year certain option). It can also be used to designate a new beneficiary for the Survivor’s Benefit Program benefit if a retiree has selected the Single Life Allowance pension payment option, or if the pension payment beneficiary is deceased (please attach a photocopy of the beneficiary’s death certificate if we do not already have it on file).

(RS6439, Rev. 9/18)

 

Survivor’s Benefit Program Beneficiary Application

To apply for the benefits payable on behalf of a deceased NYSLRS retiree as part of the Survivor’s Benefit Program.

(RS6356, Rev. 10/18)

 

Notification of Death

Your survivors should contact us to notify NYSLRS of your death so benefits can be paid to your beneficiary(ies), if applicable.

(RS6082, Rev. 10/18)

 

Affidavit for Benefit Payment (1310.4)

To make a written statement for the purpose of receiving a deceased NYSLRS retiree’s death benefit when there is no executor, administrator of the deceased’s estate, surviving spouse, minor child, or beneficiary. This affidavit follows the provisions of Section 1310.4 of the Surrogate’s Court Procedure Act.

(RS4139, Rev. 10/18)

 

Application for Direct Trustee to Trustee Transfer (Taxable)

To request the direct transfer of a deceased NYSLRS member or retiree’s death benefit to a beneficiary’s qualified plan. Use this form when the benefit amount is reportable for federal income tax purposes.

(RS5531, Rev. 11/18)

 

Application for Direct Trustee to Trustee Transfer (Non-Taxable Amount Only)

To request the direct transfer of a deceased NYSLRS member or retiree’s death benefit to a beneficiary’s qualified plan. Use this form when the benefit amount is not reportable for federal income tax purposes.

(RS5531-N, Rev. 11/18)

 

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Pension Payments

 

 

Electronic Funds Transfer Direct Deposit Enrollment Application

Use this to have your monthly benefit electronically deposited to your checking or savings account. Also used to change the bank where your benefit is deposited. This is a two-page form. Please submit page 1.

(RS6370, Rev. 12/19)

 

FORM W-4P Withholding Certificate for Pension or Annuity Payments

To adjust the federal income tax withholding that is deducted from your pension payment.

(RS4531, Rev. 3/19)

 

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Estate Planning

 

Where My Assets Are

Worksheet to help your survivors locate important documents/information upon your extended disability or death.

(VO1848, Rev. 2/19)

 

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Employer Forms


Member Registration

Membership Applications now require that you enter a Job Code. The Code you assign indicates the work the employee does and, in part, determines retirement plan eligibility. Use this Job Codes Tool to ensure you are assigning the correct code.

 

Employees’ Retirement System Membership Application

To register new ERS members. This is a two-page form. Please submit page 1.

(RS5420, Rev. 10/18)

 

Police and Fire Membership Application

To register new PFRS members. This is a two-page form. Please submit page 1.

(PF5022, Rev. 10/18)

 

Monthly Salary & Service Certification

To certify a member’s previous employment.

Note: Overtime pay in excess of an annual cap is not included in the definition of salary for Tier 5 and 6 members. See Section 6 of the Employer’s Guide for information about reporting overtime compensation.

(RS5120, Rev. 9/18)

 

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Reporting Employees

 

Standard Work Day Resolution

To establish a standard work day for employees not elected or appointed.

(RS2418, Rev. 12/19)

 

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Reporting Elected and Appointed Officials

 

Standard Work Day and Reporting Resolution

For Elected and Appointed Officials

(RS2417-A, Rev. 11/19)

 

Standard Work Day and Reporting Resolution Continuation Form

For Elected and Appointed Officials

(RS2417-B, Rev. 4/20)

 

Recertification of the Record of Activities

For Elected and Appointed Officials

(RS2419, Rev. 9/18)

 

For more information about reporting requirements, review our Elected/Appointed Officials presentation.

 

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Employee/Independent Contractor Certification Forms

 

Certification for Individuals Engaged in Certain Professions

For those hired on or after April 1, 2008

(RS2414, Rev. 9/18)

 

Certification for Determining Independent Contractor or Employee Status

For those hired before April 1, 2008

(RS2415, Rev. 9/18)

 

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Monthly Reporting

 

Adjustment Report

The Adjustment Report form is used to make corrections to the salary, service and/or contributions listed on previous monthly reports.

(RS2050, Rev. 2/19)

 

Adjustment Report Label

Used with Adjustment Report.

(RS2050-A, Rev. 1/19)

 

Adjustment Report for Pension Integrity Bureau

To make corrections to the salary, service and/or contributions listed on your employer report. Use this form if directed to do so by the NYSLRS Pension Integrity Bureau, as they will review it before processing.

(RS5527, Rev. 9/18)

 

Adjustment Report Label for Pension Integrity Bureau

Submit this form with the Adjustment Report for Pension Integrity Bureau.

(RS5528, Rev. 9/18)

 

Electronic Debit Authorization Form

To have your monthly retirement payments debited from your account electronically.

(RS5542, Rev. 3/20)

 

Employer Certification Form

To certify report information is correct and designate a security coordinator.

(Rev. 2/12)

 

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Death Notifications and Benefits

 

Notification of Death

You or your employee’s survivors should notify the Retirement System of their relative’s death so benefits can be paid to his or her beneficiary(ies), if applicable.

(RS6082, Rev. 10/18)

 

Notification of Death – Survivor’s Benefit Program

To notify the Retirement System of the death of your employee so any survivor benefits can be paid to his/her beneficiary(ies), if applicable.

(RS6358, Rev. 10/18)

 

Survivor’s Benefit Program

Eligibility of Retired Employee for Survivor’s Benefit.

Note: This form is only to be used by New York State agencies and should be printed on legal (8½ by 14 inches) paper.

(RS6355, Rev. 3/14)

 

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Retirement and Disability Related Forms

 

Statement of Accrued Payments and Leave Credits

To certify a member’s payments and credits. It must be submitted to NYSLRS before the member’s retirement can be finalized.

(RS6221, Rev. 5/18)

 

For Firefighters Paid Pursuant to Section 207-a of the General Municipal Law

To request retirement benefit information in order to determine the supplemental amount to be paid, pursuant to Section 207-a.

(PF6302, Rev. 4/19)

 

Section 211 Form

This form must be filed with and approved by the Department of Civil Service for retirees returning to work under Section 211.

(Rev. 8/16)

 

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Order Forms and Publications

 

Forms Order

To order Retirement System forms and publications. For more information, visit our Order NYSLRS Forms and Publications for Employers page.

(RS1165, Rev. 3/18)

 

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General Forms


 

Public Retirement System Special Power of Attorney Form

This form is limited to retirement benefit transactions and does not apply to any other matters. You can find information about authorizing an agent to act on your behalf on our Power of Attorney page.

(Rev. 6/18)

 

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