Office of Labor Relations Office of Labor Relations

Get Adobe PDF Reader
 (required to view PDFs)
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 Formf
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.

Summary Guide of 457 & 401(k) Plan Provisions
457/401(k) Plan Enrollment Form
Pre-Arranged Portfolio Fact Sheet
457/401(k) Plan Change Form
457/401(k) Plan Transfer of Funds Form for Incoming Plan Transfers
457 Plan In-Service Distribution Form for Purchase of Permissive Service Credits
457 Plan Small Account Withdrawal Form
457 Plan DAR Form
457 Plan Emergency Withdrawal Application
401(k) Plan Hardship Withdrawal Application
Deferred Compensation Plan Withdrawal Cancellation Form - NOT FOR DEFERRAL% CHANGES
457/401(k) Loan Guide and Applications 
457/401(k) Loan Change Form
457/401(k) Loan Offset Form
Participant Distribution Guide/Form
Beneficiary Distribution Guide/Form
Final Pension Payment/Outstanding Loan/Annuity Fund Rollover Form
Electronic Funds Transfer (EFT) Form 

NYC Deferred Compensation Plan Newsletters
December 31, 2013

NYC Deferred Compensation Plan 2014 Annual Report
2014 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)

HCFSA Medical Necessity Form
Medical Necessity Form

FSA Direct Deposit Form
FSA Program Direct Deposit Form

Plan Year 2015 Brochures and Enrollment/Change Forms
Plan Year 2015 Flexible Spending Accounts Program Brochure
Plan Year 2015 FSA Enrollment/Change Form
Plan Year 2015 MSC Health Benefits Buy-Out Waiver Enrollment/Change Form
Plan Year 2015 MSC Premium Conversion Enrollment/Change Form
Plan Year 2015 HCFSA/DeCAP SPD
Plan Year 2015 MSC SPD
Plan Year 2015 HCFSA HIPAA Form

2015 Procedures Guide
DeCAP 2015
HCFSA 2015

2015 FSA Claims Forms
2015 DeCAP Claims Form
2015 HCFSA Claims Form

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

2014 Procedures Guide
DeCAP 2014
HCFSA 2014

2014 FSA Claims Forms
 2014 DeCAP Claims Form
 2014 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
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
COBRA Application
Healthplex Dental Claim Form
Health Club Reimbursement Claim Form 
Superimposed Major Medical Claim Form
Superimposed Major Medical Part D Form
Vision Care Claim 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