01 Member Number Last 4 Digits of SSN Please read the descriptions below before choosing only one temporary option. If you choose the Maximum Retirement Allowance, do not name a beneficiary. Use your beneficiary s given name (Mary Smith, not Mrs. John Smith). Note: You may not name your Estate for either the Joint-and-Survivor or the Ten-Year Certain benefit. If you choose the 100% Joint-and-Survivor Option, you may designate only one beneficiary. Under this option, NYCERS requires proof.
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How to fill out the NY NYCERT Form 624 online
Filling out the NY NYCERT Form 624 online can seem overwhelming, but this guide will provide clear instructions to ensure you complete the form accurately. This application is specifically for Tier 6 63/10 and Special Plan members seeking Disability Retirement.
Follow the steps to complete the NY NYCERT Form 624 online.
- Press the ‘Get Form’ button to access the form and open it in an editing tool.
- Complete the personal information section, including your member number, name, contact details, and address. Ensure all information matches your records.
- Select the benefits you are applying for by checking the appropriate options provided in the 'Select a Benefit' section. Be sure to list your disabling conditions clearly.
- Choose a temporary option for your benefit. You may select between the Maximum Retirement Allowance, 100% Joint-and-Survivor, or Ten-Year Certain option. Review the descriptions carefully.
- Fill in the details for any beneficiaries you are naming under the 100% Joint-and-Survivor or Ten-Year Certain options, including their relationship to you and their personal information.
- Indicate your federal tax withholding preferences. Choose whether to withhold federal income tax and provide the necessary details per your choice.
- Read and sign the application. Ensure that your signature is acknowledged before a Notary Public or Commissioner of Deeds.
- Once completed, review the form for accuracy. You can then save your changes, download, print, or share the completed form.
Take the first step towards your disability retirement application by completing the NY NYCERT Form 624 online today.
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