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Electronic Funds Transfer Direct Deposit Enrollment Application (RS6370)
For NYSLRS retirees to have your monthly benefit electronically deposited to your checking or savings account or change which bank you deposit to.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs6370.pdfRetirement Option Election Form for Tier 2 Members (RS6163-A)
For NYSLRS Tier 2 members to elect an option for how they want their monthly benefit paid at retirement and to designate one beneficiary.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs6163-a.pdfRetirement Option Election Form For Tier 1 Members (RS6109-A)
For NYSLRS Tier 1 members to elect an option for how they want their monthly benefit paid at retirement and to designate one beneficiary.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs6109-a.pdfApplication for Performance of Duty Disability Retirement (RS6047-B)
For NYSLRS sheriffs, deputy sheriffs, undersheriffs and county correction officers in counties that elected Sections 63-B, 63-C, 607C and 607D.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs6047-b.pdfApplication for Performance of Duty Disability Retirement (RS6047-A)
For NYSLRS correction officers and security hospital treatment assistants who are covered by Chapters 653 and 722 (RSSL) to apply for a performance of duty.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs6047-a.pdfCertification for Individuals Engaged in Certain Professions (RS2414)
To certify attorneys, physicians, engineers, architects, accountants or auditors hired on or after April 1, 2008, NYSLRS employers use form RS2414 for each one.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs2414.pdfStandard Work Day Resolution for Employees (RS2418) - SAMPLE
A sample for NYSLRS employers who need to create a resolution establishing the standard working day for employees.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs2418-sample.pdfStandard Work Day and Reporting Resolution for Elected and Appointed Officials Continuation Form (RS417-B)
To add additional titles to your board resolution establishing standard work days for elected or appointed officials, NYSLRS employers use form RS2417-B.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs2417-b.pdfApplication for Police & Fire Retirement for Disability Incurred in Performance of Duty and ERS Members Covered Under Section 607-g and 89-v (RS6442)
For PFRS members to apply for a performance-of-duty disability retirement and for ERS members covered under sections 607-g or 89-v, use form RS6442.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs6442.pdfState Agencies Bulletin No. 1949
… This bulletin is superseded by Payroll Bulletin No. 1949.3 . Purpose The purpose of this … program. The overtime factor used by the New York State Payroll System (PayServ) for affected employees at these … for overtime payments that cannot be calculated by the NYS Payroll System. In addition, agencies should continue using …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1949-pilot-program-establishing-temporary-overtime-rate-employees-certainApplication for Conversion of Service or Disability Retirement to Accidental Death Benefit for Victims of the 2001 World Trade Center Disaster (RS6418-W)
To convert a retirement benefit to an accidental death benefit for victims of the 2001 World Trade Center disaster, NYSLRS beneficiaries use form RS6418-W.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs6418-w.pdfApplication for World Trade Center Accidental Disability Presumption (RS6047-W)
For NYSLRS members involved in the rescue, recovery or clean up operations of the World Trade Center aftermath to apply for a disability retirement.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs6047-w.pdfRequest to Purchase Service Credit (Including any Military Service) (RS5042)
To request service credit for your public service before you became a member of NYSLRS, or to request credit for military service, NYSLRS members use RS5042.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs5042.pdfAuthorization for Release of Health Information Pursuant to HIPAA (RS6429)
For NYSLRS members to request that health information regarding care and treatment be released to the Retirement System. HIPAA forms must be submitted with all
https://www.osc.ny.gov/files/retirement/forms/pdf/rs6429.pdfForm W-4P Withholding Certificate for Pension or Annuity Payments (RS4531)
To update your federal tax withholding, which is the amount of federal income tax withheld from your monthly pension payment, NYSLRS retirees and beneficiaries use Form W-4P (RS4531).
https://www.osc.ny.gov/files/retirement/forms/pdf/rs4531.pdfRetirement Online Contact Administrator Authorization Form for State Employers (RS5545)
This form is for State employers to authorize a Contact Administrator for Retirement Online, who will be responsible for maintaining accurate and complete business contact information for the individuals with whom NYSLRS communicates.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs5545.pdfRetirement Online Contact Administrator Authorization Form for Local Employers (RS5544)
This form is for local employers to authorize a Contact Administrator for Retirement Online, who will be responsible for maintaining accurate and complete business contact information for the individuals with whom NYSLRS communicates.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs5544.pdfRetirement Online Security Administrator Authorization Form for Local Employers (RS5546)
This form is for local employers to authorize a Security Administrator for Retirement Online, who will be responsible for submitting their location’s security authorization requests and monitoring individuals’ security access.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs5546.pdfRetirement Online Security Administrator Authorization Form for State Employers (RS5547)
This form is for State employers to authorize a Security Administrator for Retirement Online, who will be responsible for submitting their location’s security authorization requests and monitoring individuals’ security access.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs5547.pdfState Agencies Bulletin No. 1135
… Earnings Code Description BOT Marine Off Road Pay COM Command Payment EXD Expanded Duty Pay HZM Hazard Material … -.01923: Earnings Code Description BOT Marine Off Road Pay COM Command Payment EXD Expanded Duty Pay HZM Hazard Material …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1135-2011-2012-deficit-reduction-plan-employees-agency-police-services-unit