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Application for Disability Retirement - Tier 6 63/10 and Special ... 2026

The document is an application form for Disability Retirement specifically for Tier 6 63/10 and Special Plan members of the New York City Employees’ Retirement System (NYCERS). It outlines the necessary steps and forms required to apply, including a Physician’s Report of Disability, General Authorization for Release of Medical Information, and NYCERS Questionnaire. The document also details various retirement options available, eligibility criteria, and instructions for submitting the application. Additionally, it provides information on beneficiary designations and tax withholding options.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out your personal information in the 'Member Information' section. Include your Member Number, last four digits of your SSN, phone number, date of birth, and full name.
In the 'Disabling Conditions' section, list all conditions that you wish to be considered by the Medical Board. Ensure these are accurate as they will impact your application.
Select one temporary option regarding benefits if you pass away before receiving your first payment. Carefully read each option's description before making a selection.
Complete the 'Beneficiary Information' section if applicable. Provide details for any primary and contingent beneficiaries based on your selected option.
Review all entries for accuracy and completeness. Sign the form and have it notarized if submitting by mail.
Submit the completed form along with required documents online or via mail to NYCERS as instructed.

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