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The NYCERS F351 form plays a crucial role for Tier 3 and Tier 4 Disability Retirees in New York City. Each year, retirees must complete this affidavit to confirm their ongoing eligibility for disability benefits. The form requires individuals to report any Personal Service Income they earned during the year, which includes income from both public and private sectors. However, certain types of income do not need to be reported, such as pension checks, Social Security, and various investment earnings. Failing to submit this form and the necessary documentation could lead to a suspension of retirement benefits, emphasizing its importance. The form also includes a section for retirees to provide their personal information, such as pension number and Social Security number, along with a signature that must be notarized. Additionally, retirees must attach relevant tax documents, including their Federal Income Tax Return and W-2 forms, to substantiate their reported income. The process aims to ensure that benefits are distributed fairly and accurately, while also deterring fraudulent claims through strict penalties for false statements.

Similar forms

  • IRS Form 1040: This is the standard individual income tax return form used to report personal income to the federal government. Like the F351, it requires reporting of income earned during the year.
  • IRS Form W-2: Employers use this form to report wages paid to employees and the taxes withheld. The F351 also requires W-2 forms to verify income, making both documents essential for confirming earnings.
  • IRS Form 1099: This form reports various types of income other than wages, salaries, and tips. Both the 1099 and F351 are used to report income that may affect eligibility for benefits.
  • Social Security Administration (SSA) Form 1099: This form shows the total amount of Social Security benefits received. While the F351 excludes Social Security income, both documents relate to income verification for benefits.
  • New York State IT-201: This is the New York State income tax return form. Similar to the F351, it is used to report income and determine tax obligations, which can impact benefit eligibility.
  • New York State Form IT-2: This form provides information about wages and tax withheld for New York State tax purposes. Like the F351, it helps verify income for benefit eligibility.
  • NYC Department of Finance Form RP-5217: This form is used for real property transfer reporting. Although it serves a different purpose, both documents involve reporting financial information to a governmental body.
  • New York State Workers' Compensation Board Form C-3: This form is used to report injuries and claims for workers' compensation. While the F351 excludes this income, both documents deal with financial aspects related to employment.
  • Medicare Income-Related Monthly Adjustment Amount (IRMAA) Notice: This notice informs individuals of their premium amounts based on income. Both documents relate to income assessment for benefits.

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NYCERS USE ONLY

F351

 

*351*

Affidavit of Personal Service Income - 2012

Tier 3 or Tier 4 Disability Retirees

This form is to be completed annually by all Tier 3 & Tier 4 Disability Retirees. The purpose of this form is to verify your eligibility for continued disability benefits by reporting any Personal Service Income you received throughout the year. If NYCERS does not receive this affidavit, as well as the appropriate documents, your retirement benefit could be suspended until the information is received. Should you have any questions, please contact our Call Center at 347-643-3000.

Pension 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

 

 

 

 

 

 

Personal Service Income is considered to be any income, including income earned from both the public and the private sectors, you received for the year excluding the following:

-Your NYCERS’ Pension Check

-Social Security

-Workers’ Compensation

-Income earned from: rental property, stocks, bonds, IRAs and interest earned on deposits in bank accounts.

Any income earned from the above list does not have to be reported to NYCERS on this form.

A.Please answer the following questions:

1 Excluding the income listed above, have you earned any other monies for the year 2012? Yes

No

2.If you checked yes in question # 1, these monies you received are considered "Personal Service Income." Please calculate only your Personal Service Income for 2012 and place the amounts in the appropriate boxes below:

,.

(income earned from the private sector)

,.

(income earned from the public sector)

Sign this form and have it notarized, Page 2

R11/16/12

Page 1 of 2

NYCERS USE ONLY

F351

 

Pension Number

Last 4 Digits of SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. If you filed a Federal Income Tax Return for 2012, you must submit a copy of your Tax Return and your W-2 forms. If

you are married and filed a joint return, you must also submit a copy of your spouse's W-2 forms. If you did not file taxes for 2012, you still are required to submit copies of any W-2 forms you received.

I am including with this affidavit, the following:

A copy of my Federal Tax Return for the year of 2012 and my W-2 forms (if married and filed jointly please also include W-2 forms for your spouse).

I did not file my Federal Tax Return for the year of 2012 but I have attached my W-2 forms.

I did not file my Federal Tax Return for the year of 2012 and I have 0.00 Personal Service Income and no W-2 forms to submit.

To verify my eligibility for continued benefits, I have included the required documents with this affidavit.

Signature of Member

Date

 

 

 

 

Pursuant to The Penal Code of the State of New York, offering a document containing false statements or false information constitutes a felony punishable by a maximum of 4 years imprisonment. All documents suspected of containing false statements will be referred to The New York City Department of Investigation for investigation.

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.

If you have an official seal, affix it

Signature of Notary Public or

 

 

Commissioner of Deeds

 

 

 

 

 

 

 

 

Official Title

 

 

 

 

 

 

Expiration Date of Commission

 

 

 

 

 

 

 

 

Sign this form and have it notarized, THIS PAGE

R11/16/12

Page 2 of 2

Common mistakes

Completing the NYCERS F351 form can be straightforward, but many individuals make common mistakes that can lead to delays or complications in their benefits. One frequent error is failing to report all sources of Personal Service Income. Individuals sometimes overlook income from freelance work or part-time jobs, mistakenly believing that only full-time employment counts. It is essential to include all income earned during the year, excluding only the specified exceptions.

Another common mistake is neglecting to provide the required documentation. The form requests copies of Federal Tax Returns and W-2 forms, which must be submitted alongside the affidavit. Some retirees forget to include these documents or assume that they are not necessary if they did not file a tax return. However, even if no taxes were filed, W-2 forms must still be submitted if received.

Inaccuracies in personal information can also create significant issues. This includes errors in the pension number, Social Security number, or contact details. Such mistakes can lead to confusion and delays in processing the form. It is crucial to double-check all entries for accuracy before submission.

Lastly, failing to notarize the form is a mistake that can halt the entire process. The NYCERS F351 form must be signed in the presence of a Notary Public or Commissioner of Deeds. Some individuals may overlook this requirement, thinking that their signature alone suffices. Without notarization, the form will not be accepted, which could jeopardize the continuation of benefits.

More About Nycers F351

  1. What is the purpose of the NYCERS F351 form?

    The NYCERS F351 form is designed for Tier 3 and Tier 4 Disability Retirees. Its main purpose is to verify your eligibility for continued disability benefits by reporting any Personal Service Income received throughout the year. Failure to submit this form may result in the suspension of your retirement benefits.

  2. Who needs to complete the F351 form?

    All Tier 3 and Tier 4 Disability Retirees must complete the F351 form annually. This includes anyone who has received disability benefits from NYCERS.

  3. What is considered Personal Service Income?

    Personal Service Income includes any income earned from both public and private sectors, excluding certain types of income. Specifically, you do not need to report your NYCERS pension check, Social Security, Workers’ Compensation, or income from rental properties, stocks, bonds, IRAs, and bank interest.

  4. What happens if I do not submit the F351 form?

    If NYCERS does not receive your completed F351 form and the required documents, your retirement benefits may be suspended until the necessary information is provided.

  5. Do I need to submit tax documents with the F351 form?

    Yes, if you filed a Federal Income Tax Return for the year, you must include a copy of your tax return and your W-2 forms. If you filed jointly, include your spouse's W-2 forms as well. If you did not file taxes, you still need to submit any W-2 forms you received.

  6. What should I do if I have no Personal Service Income?

    If you did not file a Federal Income Tax Return and have $0.00 in Personal Service Income, you must still complete the form and indicate this. Attach any W-2 forms you received, if applicable.

  7. Is notarization required for the F351 form?

    Yes, the form must be signed and acknowledged before a Notary Public or Commissioner of Deeds. This is to verify the authenticity of the information provided.

  8. What are the consequences of providing false information?

    Providing false statements or information on this form is a felony under New York State Penal Code. It can lead to a maximum of four years of imprisonment, and any suspected false documents will be reported to the New York City Department of Investigation.

Misconceptions

Misconceptions about the NYCERS F351 form can lead to confusion for Tier 3 and Tier 4 Disability Retirees. Below are five common misconceptions along with clarifications.

  • Misconception 1: The F351 form is optional for retirees.
  • This is incorrect. The F351 form must be completed annually by all Tier 3 and Tier 4 Disability Retirees to verify eligibility for continued disability benefits.

  • Misconception 2: Only income from employment needs to be reported.
  • Retirees must report all Personal Service Income earned, excluding specific types of income such as pension checks, Social Security, and certain investment earnings.

  • Misconception 3: If I do not have any income, I do not need to submit the form.
  • Even if there is no Personal Service Income to report, the form must still be submitted to confirm that no income was earned.

  • Misconception 4: I can submit the form without any supporting documents.
  • Submission of the F351 form requires accompanying documents, such as a Federal Tax Return and W-2 forms, especially if taxes were filed.

  • Misconception 5: There are no consequences for failing to submit the form.
  • Failure to submit the F351 form can lead to suspension of retirement benefits until the necessary information is received by NYCERS.

Key takeaways

When filling out the NYCERS F351 form, it is essential to keep several key points in mind to ensure a smooth process. Below are important takeaways regarding the form's completion and use:

  • Annual Requirement: All Tier 3 and Tier 4 Disability Retirees must complete this form each year to verify their eligibility for continued disability benefits.
  • Personal Service Income Definition: Personal Service Income includes any income earned from public and private sectors, excluding specific types of income such as your NYCERS pension check, Social Security, and other defined sources.
  • Consequences of Non-Submission: Failure to submit the F351 form and the required documents may result in the suspension of retirement benefits until the necessary information is provided.
  • Tax Documentation: If a Federal Income Tax Return was filed for the year, a copy of the return and W-2 forms must be submitted. Joint filers need to include their spouse's W-2 forms as well.
  • Notarization Requirement: The completed form must be signed and notarized. This step is crucial for validating the information provided.
  • False Information Penalty: Providing false statements on this form is a serious offense under New York law, potentially resulting in felony charges.

By adhering to these guidelines, retirees can ensure that their benefits remain uninterrupted and that they comply with all necessary requirements.

Nycers F351: Usage Guide

Completing the NYCERS F351 form is essential for Tier 3 and Tier 4 Disability Retirees to maintain eligibility for disability benefits. This process involves reporting any personal service income received during the year. Follow these steps carefully to ensure your form is filled out correctly.

  1. Gather your personal information, including your pension number, last four digits of your Social Security Number, home phone number, work phone number, first name, middle initial, last name, address, apartment number, city, state, and zip code.
  2. Determine your personal service income for the year. Exclude your NYCERS pension check, Social Security, workers’ compensation, and income from rental properties, stocks, bonds, IRAs, and bank interest.
  3. Answer the first question: "Excluding the income listed above, have you earned any other monies for the year 2012?" Check "Yes" or "No."
  4. If you checked "Yes," calculate your personal service income and fill in the amounts for income earned from the private sector and public sector in the appropriate boxes.
  5. Sign the form where indicated. Ensure your signature is clear and legible.
  6. Have the form notarized. You will need to appear before a Notary Public or Commissioner of Deeds. They will verify your identity and witness your signature.
  7. Prepare any required documents. If you filed a Federal Income Tax Return for 2012, include a copy of your tax return and W-2 forms. If you filed jointly, include your spouse's W-2 forms. If you did not file taxes, include any W-2 forms you received.
  8. Attach the required documents to the completed form.
  9. Submit the completed form and documents to NYCERS as instructed.

Once you have submitted the NYCERS F351 form along with the necessary documentation, it will be reviewed by the NYCERS staff. They will verify your reported income and ensure your eligibility for continued disability benefits. If any issues arise, NYCERS will contact you for clarification or additional information.