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Get Article 15 Disability Retirement

F the New York State Comptroller New York State and Local Retirement System Employees Retirement System Police and Fire Retirement System 110 State Street, Albany, New York 12244-0001 RS 6340 (Rev. 7/11) INSTRUCTIONS: Please print plainly or type. The application must be signed on reverse side. Please call our Call Center at 1-866-805-0990 if you need help completing this application. INFORMATION ABOUT YOU 1. NAME 2. SEX: M F 4. ADDRESS 3. SOCIAL SECURITY NUMBER* XXX-XX5. REGISTRA.

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