Forms

The forms listed below are the most frequently used forms for the Plan. Contact the HELPLINE if you have questions about which form to use.

Enroll

Enrollment Kit (PDF) – It's easy to enroll. Just sign and submit your completed form through the mail.

Enrollment form (PDF – fillable)

Enrollment form (PDF – non-fillable)

Manage my account

Beneficiary Change Form (PDF) – Select, change and add beneficiaries to the Plan.

Paperless Statement Agreement (PDF) – Go green! Enroll in the eDelivery program for the following quarter's statement.

Address Change Form (PDF) – Update your mailing address, phone number and legal name.

Direct Deposit Authorization (PDF) – Add or change your checking or savings information for automatic deposits to your bank account

Manage my money

Age 50 and Over Catch-Up (PDF) – Participate in the Age 50 and over Catch-Up Provision. Learn more about catch-up options in the Learning Center.

Qualified Military Service Catch-Up (PDF) – Explains the Plan’s Qualified Military Service Catch-Up provision and how to take advantage of it. To enroll in the Qualified Military Service Catch-Up, you must meet with your Account Executive.

Self Directed Investment Account Enrollment Kit (PDF) – Begin participation in the Self Directed Investment Account offered through Charles Schwab and Co., Inc.

Self Directed Investment Account LPOA (PDF) – Limited Power of Attorney form to begin participation in the Self Directed Investment Account offered through Charles Schwab and Co., Inc.

Self Directed Investment Account Forms (PDF) – Begin participation in the Self Directed Investment Account offered through Charles Schwab and Co., Inc.

Retirement Service Credit (PDF) – Apply to purchase retirement service credit, as permitted by law, in any of New York state's public retirement systems.

In Plan Direct Rollover – Provides instructions on how to convert your pre-tax account to a Roth account within the Plan. Contact your Account Executive or call the HELPLINE to get a copy of the In Plan Direct Rollover form.

Transfer Assets into the Plan

Incoming Assets Form (PDF) – Roll money over from other retirement savings accounts into the Plan.

Deferral Updates – You can change your deferral percentage online, or by contacting an Account Executive.

Incoming IRA Transfer Form (PDF) –Transfer assets from a traditional IRA to the Plan.

Internal Plan to Plan Transfer (PDF) – Transfer assets between two employers that both participate in the Plan.

Distribution While Employed

Small Inactive Account Withdrawal (PDF) – Get the qualifications for a withdrawal from a Small Inactive Account.

Unforeseeable Emergency Withdrawal (PDF) – Apply for an unforeseeable emergency distribution.

ACH Loan Payment Request (PDF) – Initiate or change direct debit banking information for monthly Plan loan payments.

Distribution After Leaving Employment

Benefit Distribution Request (PDF) – Start the process needed to request a distribution from the Plan. Fill out this form and submit it via mail for processing. Learn more about how to start receiving income in the Learning Center.

Withholding Change Request (PDF) – Change your federal and/or state income tax withholding.

Uniform Life Table (PDF) – Determine the maximum amount of time during which benefit payments may be made to participants.

Joint and Last Survivor Life Expectancy Table (PDF) – Determine the maximum amount of time during which benefit payments may be made to them when the participant has designated their spouse as their sole beneficiary and their spouse is more than ten years younger than they are.

Direct Deposit Request (PDF) – Have your Plan distribution payments directly deposited to your savings or checking account.

Special Tax Notice (PDF) – Learn what you need to do before you decide how to receive your Plan benefits.

Required Minimum Distribution (PDF) – Learn what you need to do upon reaching age 70 and get the necessary paperwork to request a distribution.

Public Safety Officer Insurance Premium Payment Authorization (PDF) – Allows some public safety officers to request payments from the Plan to directly pay health and long–term care premiums on a tax–free basis.

Distribution of Rollover Assets (PDF) – Take a distribution from assets rolled into the Plan from another retirement plan.

Alternate Payee/Beneficiary

Alternate Payee Distribution Form (PDF) – Allows alternate payees to request distribution after a divorce or other court ordered domestic settlement. Read more about how funds are transferred and distributed in the Learning Center.

Death Benefit Distribution Claim (PDF) – Provides instructions for a beneficiary to make a withdrawal from the Plan upon the death of a participant.

Rollover Distributions

Outgoing Rollover Transfer Kit (PDF) | A Lifetime of Service Brochure (PDF) – Learn how to transfer assets from the Plan to another eligible retirement plan, including an IRA.

Transfer to a Roth IRA (PDF) – This form allows eligible participants to roll their account or a portion of their account to a Roth IRA.

PDFs require Adobe® Reader®

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