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The NYCERS F170 form stands as a crucial document for Emergency Medical Technician (EMT) members associated with the New York City Employees' Retirement System (NYCERS), defining the pathway for Tier 1, Tier 2, and Tier 4 members to opt into specialized retirement programs tailored to their unique roles. This form enables eligible EMT members, post-December 8, 2000, to elect participation in either the 25-Year Retirement Program for Tier 1 and Tier 4 members or the Optional 25-Year Improved Retirement Program for Tier 2 members. The process outlined in the form is meticulous, demanding submission within 180 days of becoming an EMT member or under specific conditions for those active on December 8, 2000. Detailed personal information, alongside employment verification, establishes the groundwork for this election which, once submitted, is irrevocable, highlighting the form's significance in securing a future retirement landscape catered specifically to the demands and service of EMT professionals within New York City's robust public service framework. Critical contact information directs members towards assistance, while the mandatory notarization underscores the document's legal importance, sealing the member's commitment to their chosen retirement trajectory. Additionally, the form serves as a reminder for members to update contact details, ensuring they remain informed about their retirement options and benefits. This intricate procedure not only underscores the city's commitment to its EMT workforce but also emphasizes the necessity of informed decision-making in securing one's financial future post-service.

Nycers F170 Sample

NYCERS USE ONLY

F170

 

*170*

Election of Optional EMT 25-Year Retirement Program

Tier 1, Tier 2 or Tier 4 Members

This is an election for Tier 1 and Tier 4 members to participate in the 25-Year Retirement Program for EMT members*, and for Tier 2 members to participate in the Optional 25-Year Improved Retirement Program. In order to participate in this program, you must be an EMT member at the time of filing this application. Please read the conditions below and complete the requested information. Should you have any questions regarding this program, please contact our Call Center at 347-643-3000.

Member Number

Last 4 Digits of SSN

Home Phone Number

( )

Work Phone Number

()

First Name

M.I.

Last Name

 

 

 

 

 

 

 

 

Address

 

 

 

Apt. Number

 

 

 

 

 

 

City

 

 

State

 

Zip Code

 

 

 

 

 

 

I understand that in order for this election to be valid pursuant to law, I must:

1.have become an EMT member after December 8, 2000

2.file this election form within 180 days of becoming an EMT Member

If you were an active EMT member on December 8, 2000, you had the option of joining this program by filing this application by June 6, 2001; however, this option has since expired.

*EMT Member: A member of NYCERS while employed by the City of New York or the NYC Health & Hospitals Corporation in a title whose duties are those of an Emergency Medical Technician (EMT), or Advanced EMT (AEMT) or in a title whose duties require the supervision of employees whose duties are those of an EMT or AEMT

ONCE THIS ELECTION IS RECEIVED BY NYCERS IT CANNOT BE REVOKED

Sign this form and have it notarized, page 2

R08/03/11

Page 1 of 2

If you have an official seal, affix it

F170

Member Number

Last 4 Digits of SSN

 

 

I hereby elect to participate in the Tier 1 or Tier 4 Optional 25-Year Retirement Program, or the Tier 2 Optional 25-Year Improved Retirement Program, and to contribute to NYCERS for the right to retire under this program.

Signature of Member

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This form must be acknowledged before a Notary Public or Commissioner of Deeds

 

 

 

 

 

 

 

 

 

 

 

 

 

State of

 

County of

 

 

On this

 

day of

 

 

2 0

 

, personally appeared

before me the above named,

 

 

 

 

 

 

, to me known, and known to

me to be the individual described in and who executed the foregoing instrument, and he or she acknowledged to me that he or she executed the same, and that the statements contained therein are true.

Signature of Notary Public or Commissioner of Deeds

Official Title

Expiration Date of Commission

HAVE YOU MOVED RECENTLY?

Old Address

New Address (check box if same as on page 1)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sign this form and have it notarized, THIS PAGE

R08/03/11

Page 2 of 2

File Overview

Fact Detail
Form Number F170
Title Election of Optional EMT 25-Year Retirement Program
Applicable Tiers Tier 1, Tier 2, or Tier 4 Members
Eligibility Must be an EMT member at the time of filing
Key Date for Eligibility Must have become an EMT member after December 8, 2000
Filing Deadline Within 180 days of becoming an EMT member
Expiration of Option for Members Active on December 8, 2000 June 6, 2001
Revocation Once elected, the decision cannot be revoked
Notarization Required Yes, form must be signed in the presence of a Notary Public or Commissioner of Deeds
Governing Law New York State

Nycers F170: Usage Guidelines

Filling out the NYCErS F170 form is essential for Tier 1, Tier 2, or Tier 4 members who wish to participate in the 25-Year Retirement Program for EMT members. This opportunity allows eligible members to adopt an optional retirement plan that suits their long-term career plans in emergency medical services. The steps to complete this form are straightforward but must be handled carefully to ensure your application is accepted and processed without delays. Once completed, a notarized signature is required to validate the form—a crucial step that formalizes your election into the program.

  1. At the top of the first page, where it says "NYCERS USE ONLY," leave this section blank.
  2. Enter your member number in the designated space.
  3. Fill in the last four digits of your Social Security Number (SSN).
  4. Provide your home phone number, including the area code, in the required format.
  5. Enter your work phone number, following the format provided.
  6. Write your first name, middle initial (M.I.), and last name in the respective fields.
  7. Fill in your address, including your apartment number, city, state, and zip code.
  8. Read the conditions provided carefully to ensure you meet all requirements for this election.
  9. Sign the form at the bottom of the first page in the space provided for the member's signature.
  10. Date the form next to your signature.
  11. On the second page, re-enter your member number and the last four digits of your SSN if required.
  12. If your address has changed, check the box marked "Have you moved recently?" and provide both your old and new addresses.
  13. Sign the second page in the designated "Signature of Member" space.
  14. Have the form notarized. This entails taking the form to a Notary Public or Commissioner of Deeds, who will verify your identity and signature. The notary will then complete the section reserved for their use, including their signature, official title, and the expiration date of their commission.

After completing and notarizing the form, you will submit it to the appropriate department or individual as directed. This form, once submitted, cannot be revoked, solidifying your decision to participate in the chosen retirement program. Make sure to keep a copy for your records and follow up if necessary, to confirm your election has been processed.

FAQ

Frequently Asked Questions about the NYCERS F170 Form:

  1. What is the NYCERS F170 form?

    The NYCERS F170 form is an official document specifically for members of the New York City Employees' Retirement System (NYCERS) who are employed as Emergency Medical Technicians (EMTs) or in supervisory positions over EMTs. It allows Tier 1, Tier 2, and Tier 4 members to elect to participate in a 25-Year Retirement Program designed for EMT members. This program offers an opportunity for an improved retirement plan based on the unique challenges and demands of their roles.

  2. Who is eligible to file the F170 form?

    Eligibility is limited to EMT members who joined NYCERS after December 8, 2000. Additionally, members must submit their election form within 180 days of becoming an EMT member. For those who were active EMT members on December 8, 2000, there was an opportunity to join this program by June 6, 2001, but this option is no longer available.

  3. What are the steps to fill out and submit the F170 form?

    Filling out the F170 form requires providing personal details, including your NYCERS Member Number, Last 4 Digits of your SSN, home and work phone numbers, and your address. After completing the form, it must be signed and notarized. The form then needs to be submitted to NYC Fall Center for processing. Keep in mind, once this election is made, it cannot be revoked.

  4. Can this election be revoked after submission?

    No, once the F170 form has been submitted and received by NYCERS, the election to participate in the chosen retirement program is irrevocable. This means that you cannot change your decision after the form has been submitted and processed.

  5. How can one get assistance while filling out the form?

    If you require assistance or have any questions regarding the F170 form or the 25-Year Retirement Program for EMT members, you are encouraged to contact the NYCERS Call Center at 347-643-3000. The Call Center can provide guidance and answer any queries related to the program and the completion of the form.

  6. What happens if an EMT member misses the 180-day deadline to file the F170 form?

    If an EMT member does not file the F170 form within 180 days of becoming an EMT member, they will miss the opportunity to elect this Optional 25-Year Retirement Program under the specified conditions. It is crucial to be mindful of this deadline to take advantage of the program offerings.

  7. Is there a deadline for members who were active on December 8, 2000?

    EMT members who were active on December 8, 2000, had a specific window to join the 25-Year Retirement Program by submitting the F170 form by June 6, 2001. Unfortunately, for those individuals, the option to elect this program under those specific terms has expired, and it is no longer possible to join under that particular provision.

Common mistakes

When filling out the NYCERS F170 form, several common mistakes can lead to processing delays or even prevent participation in the desired retirement program. Awareness and attention to detail can significantly enhance the accuracy and acceptance of your submission.

  1. Not meeting eligibility requirements: Individuals often overlook the detailed eligibility criteria, such as needing to become an EMT member after December 8, 2000, and filing the election form within 180 days of becoming an EMT member. This oversight can lead to an invalid application.
  2. Incorrect or incomplete personal information: A frequent mistake is entering incorrect personal details, like the last 4 digits of the Social Security Number (SSN), member number, or contact information. Ensuring that all personal information is accurate and current is crucial for the proper processing of the form.
  3. Missing signatures and dates: The form requires the member's signature and date at two crucial points. Many individuals forget to sign and date the form, resulting in an incomplete application.
  4. Failure to have the document notarized: The necessity of notarization is often overlooked. Not having the form notarized, or incorrectly filling out the notary section, can invalidate the entire election process.
  5. Incorrectly addressing employment status: The form is specific to certain tiers and conditions of employment with NYCERS while being employed as an EMT, AEMT, or in a supervisory role. Misidentifying one's employment status or tier can lead to rejection.
  6. Address discrepancies: If there have been recent changes in address, failing to update or check the appropriate box can lead to communication issues and delays in the election process.
  7. Not reading the instructions thoroughly: Quite often, applicants skip reading the detailed instructions provided, leading to errors in form completion that could have easily been avoided with careful review.
  8. Omitting required contributions information: The election to participate involves agreeing to contribute to NYCERS for the retirement program, a detail occasionally missed or misunderstood by applicants.
  9. Choosing the wrong retirement program: Applicants sometimes mistakenly elect to participate in a retirement program that does not align with their tier or fail to distinguish between the regular and improved retirement programs.

To avoid these pitfalls, take time to carefully review the entirety of the form, double-check personal information, ensure all required sections are completed accurately, and adhere strictly to the instructions provided. Doing so will facilitate a smoother processing of your application and help secure your election to participate in the desired retirement program.

In summary, accurately completing the NYCERS F170 form requires attention to detail, thoroughness, and an understanding of the specific requirements and conditions of the retirement program being elected. By avoiding the common mistakes outlined, applicants can enhance the likelihood of a successful election process.

Documents used along the form

When filling out the NYCERS F170 form to elect participation in a 25-Year Retirement Program for eligible EMT members, there are other documents and forms that one might need to complete or have on hand to ensure the application process goes smoothly. Below is a list of these documents, each serving its specific purpose in complementing the F170 form.

  1. Proof of Identity Document: This could be any government-issued ID that verifies the applicant's identity, such as a passport or driver's license.
  2. Birth Certificate: A certified copy is often required to prove age and eligibility for retirement benefits.
  3. Employment Verification Letter: A document from the employer confirming the applicant's EMT status and dates of service.
  4. Marriage Certificate (if applicable): Needed if electing a beneficiary option that may affect a spouse.
  5. Beneficiary Designation Form: Allows the applicant to designate who will receive benefits in the event of their death.
  6. Recent Pay Stub: Shows current employment and can help verify salary details, which might affect contribution amounts.
  7. Direct Deposit Form: For those who wish to have their retirement benefits deposited directly into a bank account.
  8. Change of Address Form (if applicable): Important if the applicant has recently moved or is planning to move.
  9. Notarization Service: While not a document, access to a notary public is required as the form needs to be notarized. Therefore, being aware of notary services available and potentially scheduling an appointment is an important step in the process.

Each document supports the F170 form submission in its own way, either by providing proof of eligibility, ensuring accurate benefit calculations, or designating beneficiaries for one's benefits. Collecting these documents in advance can make the application process for the 25-Year Retirement Program more efficient and straightforward. Knowing what's required allows applicants to be better prepared and ensures that they meet all necessary criteria for their application to be processed successfully.

Similar forms

The NYCERS F170 form, integral for EMTs seeking to elect for a special 25-Year Retirement Program, closely aligns with other documents in various retirement and benefit contexts. One such analogous form is the 401(k) election form commonly encountered in the private sector. Like the F170, a 401(k) election form enables employees to decide their contribution towards a retirement plan, specifies beneficiary details, and sometimes, investment preferences. Both documents formalize the participant’s intent and are essential for planning long-term financial security.

Similarly, the Thrift Savings Plan (TSP) election form used by federal employees mirrors the F170 in its purpose of retirement planning. The TSP form allows federal workers, including military personnel, to allocate a portion of their earnings towards a retirement savings plan. This parallels the F170’s provision for EMT members to contribute towards their specialized retirement program, emphasizing the universal need among workers to secure their financial future post-retirement.

Another document akin to the NYCERS F170 is the beneficiary designation form commonly found in life insurance policies. This form allows policyholders to designate who will receive the policy benefits upon their death, just as the F170 might include information relevant to beneficiary details in the event of the member’s death. Both forms ensure that benefits are properly allocated according to the participant or policyholder’s wishes.

The pension plan enrollment form is also comparable to the F170, as it is used by new employees or those newly eligible for pension benefits to enroll in a company or government-provided pension plan. Participants must provide personal information and make choices regarding their retirement benefits, which corresponds to the process of EMT members filing the F170 to elect participation in a specific retirement program.

Disability retirement application forms resemble the F170 in their focus on securing financial benefits for individuals unable to continue working due to disability. While the F170 is for EMTs electing a retirement program based on service length, disability forms cater to workers claiming retirement benefits based on health conditions, underscoring the broader category of securing future income under varied circumstances.

The change of address form, while administratively simpler, shares a practical connection with the second page of the F170 form. Both documents are vital for ensuring that correspondence and important documents reach the participant or member at their current address, maintaining the continuity and accuracy of communication.

The Direct Deposit Enrollment Form, used by individuals to initiate or change direct deposit details for various payments, is tied to the objective of the F170 in terms of financial transactions. Just as the F170 involves financial contributions towards a retirement plan, direct deposit forms facilitate the efficient transfer of funds, be it for payroll, benefits, or other disbursements.

Last but not least, the Individual Retirement Account (IRA) contribution form serves a very similar financial planning function as the F170. It’s used to designate contributions to either a Traditional or Roth IRA for retirement savings. Like the F170, it deals with the allocation of funds from the present earnings to support future financial security, emphasizing the importance of proactive retirement planning.

All these documents, while serving in different capacities and sectors, align with the NYCERS F170 form in their collective aim to secure a financially stable future for individuals in their retirement years, ensuring their decisions are documented and recognized legally.

Dos and Don'ts

Filling out the NYCERS F170 form is an important step for eligible Emergency Medical Technicians (EMTs) working in New York City who wish to opt into specialized retirement programs. The process, while straightforward, requires attention to detail to ensure accuracy and compliance. Here's a guide to help navigate what you should and should not do when completing this form.

Things You Should Do:

  1. Double-check your eligibility: Confirm that you became an EMT member after December 8, 2000, and are filing within 180 days of becoming an EMT member.
  2. Read carefully: Before filling out the form, carefully read all the conditions and instructions to understand your obligations and the program's benefits.
  3. Complete all requested information accurately: Fill out every field with the correct information to avoid delays or issues with your application.
  4. Contact NYCERS with questions: If you have any questions, don't hesitate to call the NYCERS Call Center at 347-643-3000 for clarification.
  5. Sign and notarize the form: Your signature must be notarized to validate the election, so make sure to sign in the presence of a Notary Public or Commissioner of Deeds.
  6. Keep a copy for your records: After notarization, make a copy of the completed form for your personal records before submitting it to NYCERS.

Things You Shouldn't Do:

  1. Do not delay: Avoid waiting too long to submit your form within the 180-day timeframe after becoming an EMT member.
  2. Do not leave sections blank: Failing to complete any part of the form can lead to processing delays or the rejection of your application.
  3. Do not guess information: If you're unsure about any details requested, verify them before entering to prevent errors.
  4. Do not sign without a notary: Remember, your signature needs to be notarized. Signing it beforehand can invalidate your submission.
  5. Do not forget to update your address: If you've recently moved, ensure your current address is correctly listed on the form to receive all correspondence.

By following these guidelines, EMT members can ensure that their NYCERS F170 form is completed correctly and promptly, paving the way to a secure and well-deserved retirement program.

Misconceptions

Many misconceptions surround the NYCERS F170 form, a crucial document for Emergency Medical Technicians (EMTs) employed by the City of New York or the NYC Health & Hospitals Corporation aiming to participate in special retirement programs. Understanding these misconceptions is essential for eligible EMT members to make informed decisions regarding their retirement benefits.

  • The first common misconception is that the F170 form is available for all NYCERS members, regardless of their tier or occupation. However, this document specifically targets Tier 1, Tier 2, or Tier 4 members who are employed as EMTs or have supervisory duties related to EMTs.

  • Another misunderstanding is that this form can be submitted at any time during an EMT's career. In reality, EMT members must file the F170 form within 180 days of becoming an EMT member or, if they were active members as of December 8, 2000, they had until June 6, 2001, to submit their application.

  • There's also a misconception regarding the ability to opt out of the program once elected. Once the F170 election form has been submitted and received by NYCERS, the decision cannot be revoked, making the commitment irreversible.

  • Many believe that the F170 form requires only the member's information and signature. However, the completion of this document also demands notarization, meaning it must be signed in the presence of a Notary Public or Commissioner of Deeds to verify the signer's identity.

  • Some members might think that filling out and submitting the form guarantees their enrollment in the elected program. Yet, understanding that this election must be valid pursuant to law, which includes specific membership qualifications, is crucial. An EMT must have become a member after December 8, 2000, for the election to be considered valid.

  • Another confusion arises with the necessity of physical submission, as some might presume digital submission is acceptable. The current process requires the election form to be physically signed and notarized, highlighting the need for a traditional paper process.

  • It's also mistakenly believed that the F170 form is a one-size-fits-all solution for retirement benefits. In fact, this form specifically elects participation in the 25-Year Retirement Program for eligible EMT members, which might not be the best choice for everyone's personal or financial situation.

  • Lastly, a significant misunderstanding is that once you submit the F170 form, no further action is required on your part. Members should be aware that maintaining accurate records, including address updates and continuing to meet eligibility requirements, is essential for successfully participating in the retirement program.

Clearing up these misconceptions is crucial for EMT members to navigate their retirement planning effectively and to make the most out of the benefits available to them through NYCERS.

Key takeaways

Filling out and utilizing the NYCERS F170 form correctly is essential for Emergency Medical Technicians (EMT) who wish to elect into a 25-Year Retirement Program within New York City's retirement system. Understanding the key takeaways can simplify the process, ensuring eligible members make informed decisions regarding their retirement options.

  • Eligibility Requirements: The option to participate in the 25-Year Retirement Program is exclusively available to EMT members within Tier 1, Tier 2, or Tier 4. It's crucial to confirm your membership tier and your role as an EMT to determine eligibility.
  • Timing is Key: For new EMT members, filing the F170 form is time-sensitive. You must submit this form within 180 days of becoming an EMT member. This strict timeframe underscores the importance of acting promptly to avoid missing the opportunity to enroll in the program.
  • Irrevocability: Once submitted, the election made with the NYCERS F170 form cannot be revoked. This emphasizes the need for careful consideration and possibly consulting with a financial advisor before making a commitment.
  • Notarization Required: The form requires notarization upon completion. This formal step is vital for the validation of the form and represents the legal acknowledgment of the member’s election and the accuracy of provided information.
  • Change of Address: Members who have recently moved need to indicate their new address on the form. Keeping contact information up-to-date ensures that NYCERS can communicate effectively with its members regarding their retirement benefits.
  • Contact Information: In case of questions or the need for further clarification about the 25-Year Retirement Program, NYCERS provides a Call Center. Utilizing this resource can help members gain a better understanding of their options and obligations.
  • Documentation Accuracy: Ensuring accurate and complete information on the form is crucial. Errors or omissions can delay processing or impact the member's eligibility for the election into the program.
  • Historical Context: For individuals who were active EMT members as of December 8, 2000, there was a window to join this program by June 6, 2001. Although this option has expired, it highlights the evolving nature of retirement benefits and the importance of staying informed about eligibility and enrollment periods.

For EMT members considering their retirement planning within NYCERS, it's imperative to pay close attention to the details of the F170 form and seek guidance if needed. Making an informed decision can significantly impact one's future financial security.

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