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Office of the New York State Comptroller’s Seal

NYS Comptroller

Thomas P. DiNapoli

Retirement System Forms

Do you need a Retirement System form? Here are the forms for Members, Retirees and Employers that are in a Portable Document Format (.pdf) format. If you do not already have the PDF reader for your browser, you can download a free copy directly from Adobe Systems. The forms can be printed, completed, notarized and mailed to the Retirement System.

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Member Forms

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

Beneficiary Changes

The quickest way to view and update your beneficiaries is by using Retirement Online, our secure, self-service web application.

Contact Information Changes

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

Contributions and Membership

  • Refund of Excess Contributions Adobe pdf

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

    (RS5195, Rev. 11/18)

  • Section 21(l) Election Form Adobe pdf

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

    (RS5379, Rev. 9/18)

  • Section 21(l) or 321(l) Cancellation Form Adobe pdf

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

    (RS5378, Rev. 9/18)

  • Tier Reinstatement Application Adobe pdf

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

    (RS5506, Rev. 10/18)

  • Transfer Membership Within NYSLRS Adobe pdf

    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 submitting the form.

    (RS5535, Rev. 6/19)

  • Transfer Membership to Public Retirement System Outside of NYSLRS Adobe pdf

    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 submitting the form.

    (RS5534, Rev. 9/18)

  • Transfer Back to ERS from PFRS Adobe pdf

    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 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 Adobe pdf

    To withdraw your Retirement System membership.

    (RS5014, Rev. 11/18)

Member Death Benefits

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Loans

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 Adobe pdf

    For all Tier 1 and 2 members (ERS and PFRS) who have annuity savings member contributions on deposit with the Retirement System. 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 Adobe pdf

    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. 2/19)

  • Loan Payment Change Form Adobe pdf

    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

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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.

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Option Election

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Option Election with Partial Lump Sum Payment

These forms are for eligible Police & Fire members, county Correction Officers, Sheriffs, Undersheriffs and Deputy Sheriffs only.

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Service Credit

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Special Retirement Plans

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Retiree and Beneficiary Forms

Death Benefits

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

    The quickest way to view and update your beneficiaries is by using Retirement Online, our secure, self-service web application. The 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 Adobe pdf

    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). 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 Adobe pdf

    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 Adobe pdf

    Your survivors 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)

  • Affidavit for Benefit Payment (1310.4) Adobe pdf

    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) Adobe pdf

    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) Adobe pdf

    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

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Estate Planning

  • Where My Assets Are Adobe pdf

    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.

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Reporting Employees

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Reporting Elected and Appointed Officials

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Employee/Independent Contractor Certification Forms

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Monthly Reporting

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Death Notifications and Benefits

  • Notification of Death Adobe pdf

    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 Adobe pdf

    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 Adobe pdf

    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

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Order Forms and Publications

  • Forms Order Adobe pdf

    To order Retirement System forms and publications.

    (RS1165, Rev. 3/18)

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General Forms

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