Retirement Forms

Complete this form if you are ready to schedule your retirement. It must be submitted between 15 and 90 days before you actually retire. This document does need to be notarized.

This form is for police & fire retirement system members and Tier 1 & Tier 2 employee retirement system members.

This form is for filing an Application for Accidental Disability Retirement. This download also includes the Authorization for Release of Health Information Pursuant to HIPAA (RS-6429).

Used to designate a beneficiary or by an agency to report an employee who is part of a Survivor's Benefits program who is retiring. This form MUST be notarized.

Use this form to add or update beneficiaries for retirement payouts.

Use this form to name the persons or entities you want to receive your life insurance proceeds after your death.

For active NYS employees, not yet retired, this form is used to change your address with the retirement system.

Use to sign up for health insurance or make changes to your existing benefits. 

This outlines the documentation that must be collected as proof of eligibility before enrolling in NYSHIP for medical, dental, and vision. Revised February 2025.

Use this form at the time of your retirement to specify that you want your dependent survivors to be able to use your monthly sick leave credit toward their NYSHIP premium if you die.

If you are eligible, use this form to defer indefinitely the activation of your New York State Health Insurance Program (NYSHIP) coverage as a retiree.

Use this form to continue, convert, or cancel life insurance coverage after retirement.

Use this form to enroll in the NYS Employees' Retirement System. 

Use this form to decline membership in the NYS Employees' Retirement System.  This form can only be used by temporary, part-time, or provisional employees.