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The NYCERS F170 form is a crucial document for Emergency Medical Technician (EMT) members seeking to participate in specific retirement programs. Designed for Tier 1 and Tier 4 members, this form facilitates enrollment in the 25-Year Retirement Program, while Tier 2 members can opt for the Optional 25-Year Improved Retirement Program. To be eligible, applicants must be EMT members at the time of filing and must have joined after December 8, 2000. The form requires essential personal information, including the member's name, address, and social security number, ensuring proper identification and processing. It is important to note that once submitted, this election cannot be revoked, emphasizing the need for careful consideration before signing. Members are also required to have their signatures notarized, further validating their commitment to the program. Understanding these requirements and the implications of the F170 form is vital for EMT members aiming to secure their retirement benefits.

Similar forms

  • NYCERS F171 Form: This form is similar to the F170 as it also pertains to retirement options for EMT members. It allows members to elect different retirement benefits, focusing on different tiers of membership.

  • NYCERS F172 Form: Like the F170, this form is used by members to apply for a specific retirement program. It may cover additional benefits or different eligibility criteria for EMT members.

  • NYCERS F173 Form: This document is related to the retirement process for EMT members. It provides options for members wishing to make changes to their retirement plans, similar to the F170.

  • NYCERS F174 Form: This form serves a similar purpose by allowing members to elect additional retirement benefits. It may cater to members with different service years or job titles.

  • NYCERS F175 Form: This document is also an election form for retirement benefits. It targets members who may have different eligibility based on their employment status or service length.

  • NYCERS F176 Form: Similar to the F170, this form allows members to choose from various retirement options. It may focus on specific benefits tailored to EMT roles.

  • NYCERS F177 Form: This form is related to retirement planning for EMT members. It provides options for members to select their preferred retirement path, much like the F170.

  • NYCERS F178 Form: This document is comparable to the F170 as it allows members to make elections regarding their retirement benefits. It often includes similar eligibility requirements and conditions.

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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

Common mistakes

Filling out the NYCERS F170 form can be a straightforward process, but many people make common mistakes that can lead to delays or complications. One frequent error is not providing the correct member number. This number is essential for identifying your account. Without it, your application may not be processed.

Another mistake is failing to include the last four digits of your Social Security Number. This information is crucial for verification purposes. Omitting it can cause unnecessary hold-ups in your application.

Many applicants also overlook the requirement to sign and date the form. Without a signature, the form is not valid. This step is critical, as it confirms your intent to participate in the retirement program.

Notarization is another area where errors occur. The form must be acknowledged before a Notary Public or Commissioner of Deeds. Some individuals forget to have their signature notarized, which can invalidate the application.

Providing outdated contact information is a common oversight. If you have moved recently, it is important to update your address on the form. Failure to do so can lead to missed communications regarding your application.

Some applicants do not read the eligibility requirements carefully. For instance, you must have become an EMT member after December 8, 2000, and file the form within 180 days of that date. Ignoring these conditions can result in disqualification from the program.

Another mistake involves misunderstanding the program options. Applicants sometimes select the wrong tier, such as Tier 1 instead of Tier 2. Ensure that you fully understand which program you are applying for to avoid this error.

Lastly, many people do not keep a copy of the completed form for their records. Retaining a copy can be helpful if any questions arise about your application in the future. Keeping track of your paperwork is always a wise practice.

More About Nycers F170

  1. What is the NYCERS F170 form?

    The NYCERS F170 form is an election form for certain members of the New York City Employees' Retirement System (NYCERS). It allows Tier 1 and Tier 4 members to participate in the 25-Year Retirement Program for Emergency Medical Technicians (EMT), and it allows Tier 2 members to join the Optional 25-Year Improved Retirement Program. To be eligible, you must be an EMT member when you file the application.

  2. Who can file the F170 form?

    Only EMT members who became members after December 8, 2000, can file this form. If you were an active EMT member on that date, you had a one-time option to join the program, but that option has since expired. It’s crucial to file the form within 180 days of becoming an EMT member to ensure your election is valid.

  3. What information do I need to provide on the form?

    You will need to provide several details, including:

    • Your member number
    • The last four digits of your Social Security Number (SSN)
    • Your home and work phone numbers
    • Your full name (first name, middle initial, last name)
    • Your address, including apartment number, city, state, and zip code
  4. What happens once I submit the F170 form?

    Once NYCERS receives your completed F170 form, it cannot be revoked. This means that your election to participate in the retirement program is final. Be sure to review your information carefully before submission.

  5. Do I need to have the form notarized?

    Yes, the F170 form must be signed and notarized. You will need to acknowledge your signature before a Notary Public or Commissioner of Deeds. This step is essential for the validity of your election.

  6. Who can I contact if I have questions about the F170 form?

    If you have any questions regarding the F170 form or the retirement program, you can reach out to the NYCERS Call Center at 347-643-3000. They can provide assistance and clarify any doubts you may have.

Misconceptions

Understanding the NYCERS F170 form can be challenging, and several misconceptions may lead to confusion. Here are nine common misconceptions about this form, along with clarifications to help you navigate the process more effectively.

  1. Only new EMT members can use the F170 form. Many believe that only those who just became EMT members can file the F170 form. However, any Tier 1 or Tier 4 member who meets the eligibility requirements can elect to participate in the program, as long as they became an EMT member after December 8, 2000.
  2. The form can be submitted anytime. Some think there is no deadline for submitting the F170 form. In reality, it must be filed within 180 days of becoming an EMT member to be valid.
  3. All EMT members qualify for the 25-Year Retirement Program. It's a common belief that all EMT members are eligible for this program. However, eligibility is limited to Tier 1 and Tier 4 members, and Tier 2 members can only opt for the Optional 25-Year Improved Retirement Program.
  4. Once submitted, the election can be changed. Many assume that they can change their election after submitting the form. Unfortunately, once the F170 form is received by NYCERS, it cannot be revoked.
  5. Notarization is optional. Some individuals think that notarizing the form is not necessary. However, the form must be acknowledged before a Notary Public or Commissioner of Deeds to be considered valid.
  6. The F170 form applies to all retirement plans. It is a misconception that the F170 form is applicable to any retirement plan. This form specifically pertains to the Optional 25-Year Retirement Program for EMT members.
  7. Previous EMT membership counts towards eligibility. Some believe that prior membership as an EMT before December 8, 2000, qualifies them for the program. This is not true; only those who became EMT members after that date are eligible.
  8. Contacting NYCERS is unnecessary. Many think they can figure everything out on their own. However, if you have questions regarding the F170 form or the retirement program, reaching out to NYCERS is encouraged for accurate guidance.
  9. Personal information is not important on the form. Some underestimate the importance of providing accurate personal information. It's crucial to fill out all requested information correctly, as it ensures proper processing of your application.

By addressing these misconceptions, you can better understand the NYCERS F170 form and its requirements. Always ensure you have the correct information and seek assistance if needed.

Key takeaways

  • The NYCERS F170 form is essential for EMT members wishing to join the 25-Year Retirement Program.
  • Eligibility is limited to Tier 1 and Tier 4 members, as well as Tier 2 members for the Optional 25-Year Improved Retirement Program.
  • Applicants must be active EMT members at the time of filing the application.
  • To ensure a valid election, the form must be submitted within 180 days of becoming an EMT member.
  • If you were an active EMT member on December 8, 2000, you had a one-time option to join the program, which has since expired.
  • Once submitted, the election cannot be revoked, making it a significant decision.
  • The form requires personal information, including your member number, last four digits of your Social Security Number, and contact details.
  • A notarization is mandatory for the form to be valid, ensuring authenticity of the signature.
  • If you have moved recently, update your address on the form to avoid any discrepancies.

Nycers F170: Usage Guide

After gathering the necessary information, individuals can proceed to fill out the NYCERS F170 form. This process involves providing personal details, confirming eligibility, and ensuring the form is properly signed and notarized.

  1. Obtain the NYCERS F170 form from the official NYCERS website or your local NYCERS office.
  2. Fill in your Member Number in the designated field.
  3. Enter the Last 4 Digits of your Social Security Number.
  4. Provide your Home Phone Number and Work Phone Number in the appropriate spaces.
  5. Write your First Name, Middle Initial, and Last Name in the respective fields.
  6. Complete your Address, including Apt. Number, City, State, and Zip Code.
  7. Review the eligibility conditions to ensure you qualify:
    • You must have become an EMT member after December 8, 2000.
    • You must file this election form within 180 days of becoming an EMT member.
  8. Sign the form in the designated area to indicate your election to participate in the retirement program.
  9. Include the Date of your signature.
  10. Have the form notarized by a Notary Public or Commissioner of Deeds. Ensure the notary fills out their section, including their signature, official title, and expiration date of their commission.
  11. If you have moved recently, provide your Old Address and New Address. Check the box if the new address is the same as the one on the first page.

Once completed, submit the form to NYCERS. Ensure that all information is accurate to avoid any delays in processing your application.