Office of Labor Relations Office of Labor Relations



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Forms and Downloads


The following forms and publications are in PDF format. Follow the link at left to download Acrobat Reader if you don't already have it.

New York City Employee Individual Retirement Account (NYCE IRA), Brochures & Forms

NYCE IRA Brochure (includes Application)
NYCE IRA Deposit Form
NYCE IRA Transfer/Rollover Form
NYCE IRA Personal Information Change Request Form
Traditional NYCE IRA Withdrawal Form
Roth NYCE IRA Withdrawal Form
NYCE IRA Withdrawal Cancellation Form
NYCE IRA Beneficiary Withdrawal Form
Single Life Expectancy Table
Joint Life Expectancy Table
The Uniform Table 

NYC Deferred Compensation Plan Guides, Brochures & Forms
Please Note: To request a pension rollover packet, including the Final Pension Payment Rollover Form, please call (212) 306-7760.

NYC Deferred Compensation Plan Newsletters
December 31, 2013

NYC Deferred Compensation Plan 2013 Annual Report
2013 Annual Report

City Health Benefits

Health Benefits Application with Instruction Sheet
Basic Plan and Optional Rider Costs for Employees
Plan Costs for Non-Medicare Retirees and Medicare-Eligible Retirees

Flexible Spending Accounts Program

HIPAA Rights (For the HCFSA Program only)

Plan Year 2014 Brochures and Enrollment/Change Forms
Plan Year 2014 Flexible Spending Accounts Program Brochure
Plan Year 2014 FSA Enrollment/Change Form
Plan Year 2014 MSC Health Benefits Buy-Out Waiver Enrollment/Change Form
Plan Year 2014 MSC Premium Conversion Enrollment/Change Form
Plan Year 2014 HCFSA/DeCAP SPD
Plan Year 2014 MSC SPD
Plan Year 2014 HCFSA HIPAA Form

FSA Procedures Guide
DeCAP 2014
HCFSA 2014

DeCAP 2013
HCFSA 2013

HCFSA Medical Necessity Form
Medical Necessity Form

FSA Direct Deposit Form
FSA Program Direct Deposit Form

FSA Claims Forms
DeCAP Claims Form
HCFSA Claims Form 

Long Term Care Insurance Program 
Long Term Care Insurance Program Change Form

Management Benefits Fund

HIPAA Rights (For MBF only)

MBF Booklet Sections
General Information
Basic Life Insurance and AD&D
COBRA
Dental Benefits
Family and Medical Leave Act (FMLA)
Fund Eligibility and Membership
GHI Senior Care Drug and Medicare Supplement Health Plan Rider Subsidy Benefit
Group Universal Life (GUL) Insurance
Health Club Reimbursement Program
Long-Term Disability (LTD) Insurance
Retiree Medicare HMO Drug Benefits
Special Leave of Absence Coverage (SLOAC)
Superimposed Major Medical Plan (SMMP) Benefits
Survivor Benefits
Vision Care Benefits

Complete MBF Booklet
MBF Booklet


Management Benefits Fund Forms 
 

 

Young Adult Dependent Direct Pay Coverage Continuation (DPCC) Form
Dependent Eligibility Form for Young Adult Children
COBRA Application
Healthplex Dental Claim Form
Dependent Student Certification Form
Health Club Reimbursement Claim Form 
Superimposed Major Medical Claim Form
Superimposed Major Medical Part D Form
Vision Care Claim Form
MBF HIPAA Form

MBF Voice Newsletters
January 2012
Winter 2009

Lost Check Claim
To submit a claim for a lost check from the Deferred Compensation Plan, the Management Benefits Fund, the Dependent Care Assistance Program, or the Health Care Flexible Spending Account Program.

Lost Check Claim Form