Application for Service Retirement NY State
This file contains the official application for service retirement from the New York State and Local Retirement System. It provides essential information and instructions for public employees seeking to retire. Complete and submit this application to initiate your retirement benefits.
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How do I fill this out?
To fill out this application, start by providing your personal information, including your name and Social Security number. Next, complete the employment history section, detailing your public service. Finally, ensure all required signatures and notary acknowledgment are included to finalize the application.

How to fill out the Application for Service Retirement NY State?
1
Gather all necessary personal and employment information.
2
Carefully fill in each section of the application form.
3
Double-check to ensure all required fields are completed.
4
Sign the application in full and have it notarized.
5
Submit the completed application to the designated office.
Who needs the Application for Service Retirement NY State?
1
Public employees who are nearing retirement and need to apply for retirement benefits.
2
Individuals who have served in the armed forces and want to secure retirement credits.
3
Previous members of New York public retirement systems applying for tier reinstatement.
4
Employees seeking guidance on their retirement options and beneficiaries.
5
New York State residents looking to understand the retirement process.
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What are the instructions for submitting this form?
To submit this form, send it to the New York State Comptroller's office at 110 State Street, Albany, New York 12244-0001. You may also submit by fax at (518) 474-6976. For online submissions, refer to the retirement system's official website for guidance on how to proceed with electronic filing.
What are the important dates for this form in 2024 and 2025?
Make sure to note the following important dates: The application should be filed 15 days prior to your intended retirement date. Submissions after this point may affect your benefits. Always keep an eye on any changes in submission guidelines or deadlines in future years.

What is the purpose of this form?
This form is essential for public employees in New York who wish to apply for retirement benefits. It serves to document your eligibility for retirement under the New York State and Local Retirement System. Completing this application accurately ensures that you receive the benefits you have earned.

Tell me about this form and its components and fields line-by-line.

- 1. Name: Your full legal name as it appears on your identification.
- 2. Social Security Number: Your Social Security Number for identification purposes.
- 3. Address: Your current residential address.
- 4. Telephone Number: Contact numbers for home and work.
- 5. Date of Birth: Your date of birth for age verification.
- 6. Effective Retirement Date: The date you intend to retire.
What happens if I fail to submit this form?
Failure to submit this form may result in delayed access to your retirement benefits. If the application is incomplete or not submitted correctly, it could lead to complications in processing your retirement allowance.
- Delay in Benefits: An incomplete application can postpone the disbursement of your retirement allowance.
- Rejection of Application: Submitting an application without required information may lead to its rejection.
- Missed Retirement Date: If not submitted on time, you might miss your intended effective retirement date.
How do I know when to use this form?

- 1. Retirement Application: To formally apply for your retirement benefits.
- 2. Tier Reinstatement: For those returning to a previous retirement membership tier.
- 3. Employment Records: To document your public service history for accurate benefit calculation.
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What information do I need to complete the application?
You'll need personal details including your name, Social Security number, and employment history.
Is there a deadline for submission?
Make sure to submit your application at least 15 days before your retirement date.
What happens if my application is incomplete?
If your application is incomplete, it may be rejected or delayed in processing.
How can I ensure my application is processed on time?
Submit your application as early as possible and ensure all required fields are completed.
Can I save my changes in PrintFriendly?
Yes, you can save your edited PDF to your device after making changes.
Will I receive confirmation of my submission?
Yes, typically you will receive confirmation once your application has been processed.
What support is available if I have questions?
You can contact the New York State and Local Retirement System for assistance with your application.
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