New York City Police Pension Fund
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Forms and Publications

Instructions:                                                                                           

 1

 Click form name to download.      

 2

 Read and follow all instructions.      

 3

 Notarize form if mailing it to the NYCPPF. 
                                                                       
 

ACTIVE MEMBERS

 

Membership: Tier:
10

Tier 3 Enhanced Plan Election

3
Beneficiary:

 

60

Beneficiary Designation 

2,3

61

Supplemental Beneficiary Designation 

2,3

62

Minor Beneficiary Custodian Designation 

2,3

  Buybacks/RMS:

 

15

EMT/Peace Officer Service (Ch. 498) 

2

20

Child Care Leave (Ch. 594)

2

25

Foreign Police Service (Ch. 606) 

2,3

26

Verify Foreign Police Service (Ch. 606)

2,3

30

RSSL 1000

2,3

35

Prior NYC or NYS Service (Ch. 552) 

2,3

40

Prior NYC or NYS Service Credit (Ch. 646) 

2,3

45

NYC Deferred Compensation Plan Distribution 

2,3

47

Retroactive Military Seniority (RMS) -- Tier 2

2

48

Retroactive Military Seniority (RMS) -- Tier 3

3

  Pension Account:  

50

50% Additional Contributions 

2

55

ITHP (Increased Take-Home Pay) 

2

65

Pension Contributions (STOP or REINSTATE) 

2

70

Pension Statement Request 

2,3

75

Refund or Rollover of Excess  w. Special Tax Notice (7 pp.)

2

80

Refund/Transfer/Rollover of Contributions w. Special Tax Notice  (7 pp.)

2,3

85

Shortage Status Request 

2

86

Pension Recalculation Request (Goodman Settlement)

2,3

  Pension Loan:  

90

Pension Loan Application 

2

100

Change Loan Repayment Amount 

2

110

Loan Cancellation 

2

  Membership Transfers:   

115

NY City Employee Retirement System (NYCERS) 

2,3

120

NYC Board of Education Retirement System (BERS) 

2,3

125

NY State and Local Retirement System (NYSLERS) 

2,3

130

NY Fire Department Pension Fund (FDNY) 

2,3

     
 

RETIRED MEMBERS

 

170

Option and Beneficiary Selection

175

Change of Address   

180

Direct Deposit/EFT (START or CHANGE)   

185

STOP Direct Deposit (EFT)   

190

Federal Income Tax Withholding Form (2017 W4-P)   

200

Employment Certification (RSSL, §212)   
201 Financal Disclosure Questionnaire (FDQ, 2016)

205

Lost Check Affidavit   

210

Pension Award Letter Request    

215

VSF Suspension 
 217 Unidentified Goodman Class Member Claim  
 

ALL MEMBERS

 
 -- Sample DRO Forms   
195 Municipal Credit Union Deduction (START/CHANGE/CANCEL)
225 Request Pension Valuation in Matrimonial Action 
230 Member Records/File Request   
240 Authorization