The following forms and publications are in PDF format. Follow the link at left to download Acrobat Reader if you don't already have it.

New York City Employee Individual Retirement Account (NYCE IRA), Brochures & Forms
NYCE IRA Brochure (includes Application)
NYCE IRA Deposit Form
NYCE IRA Transfer/Rollover Form
NYCE IRA Personal Information Change Request Form
Traditional NYCE IRA Withdrawal Form
Roth NYCE IRA Withdrawal Form
NYCE IRA Beneficiary Withdrawal Form
Single Life Expectancy Table
Joint Life Expectancy Table
The Uniform Table

NYC Deferred Compensation Plan Guides, Brochures & Forms
Please Note: To request a pension rollover packet, including the Final Pension Payment Rollover Form, please call (212) 306-7760.

Summary Guide of 457 & 401(k) Plan Provisions
457/401(k) Plan Enrollment Form
Pre-Arranged Portfolio Fact Sheet
457/401(k) Plan Change Form
457/401(k) Plan Transfer of Funds Form for Incoming Plan Transfers
457 Plan In-Service Distribution Form for Purchase of Permissive Service Credits
457 Plan DAR Form
457 Plan Emergency Withdrawal Application
401(k) Plan Hardship Withdrawal Application
457/401(k) Loan Guide and Applications
457/401(k) Loan Change Form
457/401(k) Loan Offset Form
Participant Distribution Guide/Form
Beneficiary Distribution Guide/Form
Electronic Funds Transfer (EFT) Form 

NYC Deferred Compensation Plan Newsletters
December 31, 2010
March 31, 2010
September 30, 2009
June 30, 2009
Special Edition February 2009

NYC Deferred Compensation Plan 2010 Annual Report
2010 Annual Report

City Health Benefits
Health Benefits Application with Instruction Sheet
Basic Plan and Optional Rider Costs for Employees
Plan Costs for Non-Medicare Retirees and Medicare-Eligible Retirees

Flexible Spending Accounts Program

Plan Year 2012 Brochures and Enrollment/Change Forms
Plan Year 2012 Flexible Spending Accounts Program Brochure
Plan Year 2012 FSA Enrollment/Change Form
Plan Year 2012 MSC Health Benefits Buy-Out Waiver Enrollment/Change Form
Plan Year 2012 MSC Premium Conversion Enrollment/Change Form
Plan Year 2012 HCFSA/DeCAP SPD
Plan Year 2012 MSC SPD
Plan Year 2012 HCFSA HIPAA Form

HCFSA Medical Necessity Form
Medical Necessity Form

FSA Direct Deposit Form
FSA Program Direct Deposit Form

FSA Claims Forms
DeCAP Claims Form
HCFSA Claims Form 

Long Term Care Insurance Program 
Long Term Care Insurance Program Change Form

Management Benefits Fund
Young Adult Dependent Direct Pay Coverage Continuation (DPCC) Form
Dependent Eligibility Form for Young Adult Children
COBRA Application
Healthplex Dental Claim Form
Dependent Student Certification Form
Health Club Reimbursement Claim Form 
Superimposed Major Medical Claim Form
Superimposed Major Medical Part D Form
Vision Care Claim Form
MBF HIPAA Form


MBF Booklet Sections
General Information
Basic Life Insurance and AD&D
COBRA
Dental Benefits
Family and Medical Leave Act (FMLA)
Fund Eligibility and Membership
GHI Senior Care Drug and Medicare Supplement Health Plan Rider Subsidy Benefit
Group Universal Life (GUL) Insurance
Health Club Reimbursement Program
Long-Term Disability (LTD) Insurance
Retiree Medicare HMO Drug Benefits
Special Leave of Absence Coverage (SLOAC)
Superimposed Major Medical Plan (SMMP) Benefits
Survivor Benefits
Vision Care Benefits

MBF Voice Newsletters
Winter 2009
May 2007

Lost Check Claim
To submit a claim for a lost check from the Deferred Compensation Plan, the Management Benefits Fund, the Dependent Care Assistance Program, or the Health Care Flexible Spending Program.

Lost Check Claim Form