What Is this Form for
To identify and withhold the correct New York State, New York City, and/or Yonkers tax. If you do not submit this form, your withholdings will default to a filing status of “single” and you claim “1” allowances.
If you transferred from another state agency, your withholding elections will transfer with you.
Download the Form:
Is this Form Mandatory
How to Complete this Form
Skip the paper by changing your New York withholdings online using NYS Payroll Online.
Paper form instructions:
This form is fillable.
- Type in your personal information int he top section.
- Answer questions 1-5.
- Print the form.
- Sign your name on the "Employee's Signature" line and date.
- Send the original, signed form to the BSC.
How to Submit this Form
BSC Payroll Administration
W. Averell Harriman State Office Campus
1220 Washington Avenue
Building 5, Floor 4
Albany, NY 12226-1900
Contact the BSC Payroll Admin Team
Still have questions? Try the BSC Help Center where you can send a question to our support team or search a database of FAQs.