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

63 Beneficiary Fact Sheet   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

146

Chapter 431 Buyback – Tier 3 Cadet Bill

  3
       
 

RETIRED MEMBERS

   

170

Option and Beneficiary Selection    

175

Change of Contact Information
   

180

Start or Change  Electronic Fund Transfer (EFT)
   

185

Stop Electronic Fund Transfer (EFT)     

190

Tax Withholding Form (W4P)     

200

Employment Certification (RSSL, §212)     
201 Financial Disclosure Questionnaire (FDQ, 2021)    

205

Lost Check Affidavit     

210

Pension Award Letter Request      

215

VSF Suspension     
 217 Unidentified Goodman Class Member Claim    
       
 

ALL MEMBERS

   
220 Sample DRO Forms     
194

Change of Social Condition

   
195 Start, Change or Cancel Municipal Credit Union Deduction
   
225 Request Pension Valuation in Matrimonial Action     
230 Member Records/File Request     
240 Third Party Authorization      
250 WTC Notice of Participation    
260

POA Affidavit