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Member Documents


Retirement and Pension Plan Officers and Employees of NYCDCC Beneficiary Form
Disability Pension Application
Pension Appeal Form
Pension Application

Disbursement Documents

Stop Payment Request Form


Benefit Shortage Form
Benefits Opt In Form
Change-of-Address Form
Direct Deposit Authorization Form
Disqualifying Employment Questionnaire
Health Plan Enrollment Form
NYCDCC Beneficiary Designation Form
Proof of Claim for Disability Benefits
Reciprocal Authorization Form
Required Documents for Eligible Dependents
W-4P Form 2017
Health Insurance Claim Form- Empire
Health Plan Enrollment- Required Documents
Medicare and You 2017
Prescription Mail Order Form- English
Prescription Mail Order Form- Spanish
Private Health Information Authorization Form
SBC Uniform Glossary


To request any forms or documents that you do not see available on the website, please call the Benefit Funds Call Center at (800) 529-FUND (3863) or (212) 366-7373.