Get Ps-405 Dual Annuitant Form - Cs Ny

This guide provides a step-by-step approach to completing the PS-405 Dual Annuitant Form - Cs Ny online. By following these instructions, users can ensure they accurately fill out the form to benefit from their sick leave credit in retirement.

Follow the steps to complete the PS-405 Dual Annuitant Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the digital editor.
2. Read the form instructions carefully. Pay particular attention to your options for electing between the Single-Annuitant or Dual Annuitant options.
3. In the section titled 'Check One', select either the 'Single-Annuitant Option' or 'Dual-Annuitant Option' by marking the appropriate box. Make sure you understand the implications of each choice before making your selection.
4. Review the descriptions for the options you have selected to ensure you understand how your sick leave credit will be applied towards your monthly health insurance premium.
5. Fill in your name and address in the designated fields. Ensure that all personal details are accurate and complete.
6. Enter the date you are filling out the form in the corresponding date field.
7. Provide your Health Insurance ID Number in the specified field to ensure proper processing of your form.
8. Sign the form to validate your selection and acknowledgment of the information regarding the Dual Annuitant Sick Leave Credit.
9. If required, obtain the signature of your Agency Health Benefits Administrator and ensure the Agency Name and Agency Code are filled out correctly.
10. Once all required fields are completed, review the form for accuracy. After verifying the information, save your changes, download a copy, print it, or share the completed form as needed.

Complete your PS-405 Dual Annuitant Form online today for a smooth retirement health insurance process.