Forms to be completed by PEF-represented employees:

All forms are in Adobe Acrobat format.

Benefits Forms

Health Insurance

Eligibility

• Proof of Eligibility for Health Insurance (memo)

Enrollment

• PS-404 NYS Health Insurance Transaction Form (all benefits eligible employees must complete this form)
• Health Insurance Pre-Tax Contribution Program Form
• Employee Notice and Fact Sheet (NYS Public Employee Long Term Care Insurance Plan)

Retirement

• New York State Employees' Retirement System Article 15 Membership Registration Form
• Surivors' Benefit Program Form (if part time and declining to enroll in State Employees' Retirement System)

Payroll Forms/Documents

Tax Forms

• Federal Tax Form / W-4
• State Tax Form / IT-2104
• State Exempt Tax Form / IT-2104E (if filing exempt)

Payroll Forms/Documents

• Direct Deposit Form
• Annual / Hourly Pay Period Schedule
• Paycheck Tool - PEF
• Understanding Your State Paycheck

Other Forms/Documents

• Oath of Office
• Oath of Office - Native American
• Veteran Status Form
• Check Diversion Form
• Upstate Annual Calendar