Get Nj Fb-0504 2023-2025

The NJ FB-0504 form is a request for USERRA-eligible service, allowing members to request benefits related to their military service. This guide provides clear, step-by-step instructions to help users complete the form efficiently and accurately.

Follow the steps to successfully fill out the NJ FB-0504 online.

1. Click ‘Get Form’ button to retrieve the NJ FB-0504 form and open it for completion.
2. Begin by selecting the appropriate program under the ‘check one’ section. Choose from Public Employees’ Retirement System, Police and Firemen’s Retirement System, Alternate Benefit Program, Teachers’ Pension and Annuity Fund, State Police Retirement System, or Judicial Retirement System.
3. In Part 1 — Member Information, complete all required fields, including employee name, address (street, city, state, zip code), membership number, social security number, date left public employment for uniformed service, name of former employer, and the dates of uniformed service. Attach any supporting documentation, such as military orders.
4. Ensure you sign and date the form in the designated signature section at the end of Part 1.
5. Move to Part 2 — Employer Certification. This section should be filled out by the certifying officer from the employer. They must provide the employer name, date of return to public employment, and pensionable salary information, including what the employee would have earned during the eligible military service period.
6. The certifying officer must also complete the statement certifying eligibility for pension benefits and sign their name along with their title and date.
7. After both parts have been completed and reviewed for accuracy, you can save changes, download the form, print it, or share it as needed.

Complete your NJ FB-0504 form online today for a smooth application process.