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This page contains printable versions of most NYSTRS forms. If you are unable to view or print these PDF files, you may need to download a free copy of Adobe Reader . When mailing completed forms to NYSTRS, note that if sent by Certified or Registered mail, we will consider it received on its postmark date.
If you would prefer to receive these or other System forms by mail, request them by calling our Hotline at (800) 782-0289.
Prior Service Forms
Prior Service Credit
Claim (PRS-2; updated 4/05)
Verification of NYS Teaching (PRS-3; updated 7/05)
Verification of Uncredited NYC Teaching Covered by Membership in a Retirement System (PRS-3.1; updated 10/05)
Verification of Uncredited NYC Teaching Not Covered by a Retirement System (PRS-3.2; updated 3/05)
Verification of Other NYS Public Employment
(PRS-3.5; updated 10/04)
NYC Subsequent Service under Chapter
352 of the Laws of 2002 (MAC-79; updated 10/04)
Claim for Service Credit Under Chapter 675 of the Laws of 2006 (MAC-80; posted 3/07)
Subsequent Service Claim for Discontinued Members (For Service Rendered 12/1/91
– 6/30/02) (MAC-4; updated 3/03)
STRS Service Credit (NET-2.4; updated 12/04)
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Forms That May Be Needed
at Retirement
Note: You can file a service retirement application up until
your effective date of retirement, but no more than 90 days before
your retirement date.
Service Retirement Application
(RET-54; updated 5/07)
Proof of Date of Birth (RET-45; updated 2/02)
Distribution Election for ASF
– Tier 1 and 2 (REF-30; updated 1/07)
Direct Rollover of
Taxable ASF (REF-30.2; updated 11/06) If filed, must submit with Distribution
Election for ASF (REF-30).
Direct Rollover of After-Tax ASF
(REF-30.3; updated 11/06) If filed, must submit with Distribution Election for ASF (REF-30).
Disability Retirement Application Package
(RET-54.1 (1/07); RET-54.3A (6/03); RET-54.5 (1/05); RET-54.1B (1/02); RET-54.3 (1/02)). Please refer to NYSTRS' If You Are No Longer Able to Work brochure, which offers guidelines for making disability retirement decisions.
Additional Medical Report for Disability
Retirement Applicants (RET-54.3; updated 1/02)
Election of Retirement Benefit
(RET-54.6; if you need to change the benefit payment choice you
made on your retirement application, you may file this form within
30 days of your retirement date; updated 2/03)
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Membership
Withdrawal Forms
Fact Sheet (REF-18.1; updated 1/08)
Application for Withdrawal From Membership (REF-7A; updated 1/07) Includes the Tax Notice Regarding Withdrawal of Contributions (REF-7.1).
Direct Rollover of
Taxable Contributions (REF-30.2; updated 11/06) If filed, must submit with
Application for Withdrawal From Membership (REF-7A).
Direct Rollover of After-Tax Contributions
(REF-30.3; updated 11/06) If filed, must submit with
Application for Withdrawal From Membership (REF-7A).
Membership Transfer out
of STRS (TRF-3; updated 5/02)
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Other Forms for
Active Members
Name/Address Change (GRE-50; updated 3/05)
Beneficiary Designation
or Change (NET 11.4; updated 2/03)
Benefit Estimate Request
Loan Application
(LON-26; updated 1/08)
Membership Application (NET-2; updated 10/04)
Election to Reinstate
(RIS-1; updated 7/03)
Trust Certification (LEG-1; updated 2/02)
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Direct Deposit Authorization
Agreement (GRE-54; updated 3/05)
Retiree Change of Address
(GRE-52; updated 3/05)
W-4P Withholding
Election and Certificate (FIN-149; updated 2/08)
Beneficiary Change for Retirees Who
Elected a Guarantee Period Option (RMS-5.3; updated 1/02)
Beneficiary Change for Retirees Who Elected
a Lump Sum Option (RMS-5; updated 12/01)
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