Income Verification Affidavits
Payroll Verification Affidavit
Form #355
NYCERS periodically requests completion of this form by certain retirees to verify your account and ensure that you are receiving your benefits.
Affidavit of Personal Service Income
Form #351
This form is to be completed annually by all Tier 3, Tier 4 and Tier 6 Disability Retirees to verify your eligibility for continued disability benefits. Find out more about Personal Service Income.
Affidavit of Workers’ Compensation Payments
Form #354
Use this affidavit to report Workers’ Compensation payments you have received, and/or are currently receiving.
Safeguards Information Affidavit
Form #350
This form is to be completed annually by all Tier 1 and Tier 2 Disability Retirees to verify your eligibility for continued disability benefits.