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Fill a Valid Nycers F351 Template

The NYCERS F351 form is a critical document for Tier 3 and Tier 4 Disability Retirees within the New York City Employees' Retirement System (NYCERS). Its main purpose is to ensure the continued eligibility of disability benefits recipients by requiring them to report any Personal Service Income received throughout the year. Failure to submit this affidavit, along with the required documentation, may result in the suspension of retirement benefits until compliance is achieved.

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The New York City Employees' Retirement System (NYCERS) necessitates that all Tier 3 and Tier 4 Disability Retirees annually complete the F351 form, an Affidavit of Personal Service Income. This critical process ensures that these retirees maintain their eligibility for continued disability benefits by disclosing any personal service income they've received over the year. Not only is the submission of this affidavit mandatory, but the failure to provide it alongside the relevant documentation could result in a suspension of retirement benefits until compliance is achieved. This form distinguishes between various income types, explicitly excluding certain sources like the retiree's NYCERS’ pension check, Social Security benefits, Workers' Compensation, and income derived from rental property, stocks, bonds, IRAs, and interest on bank deposits from the need to report. Moreover, the affidavit demands details of any personal service income from both the public and private sectors for the stipulated year, which in the document provided is 2012. It also outlines the necessary steps for those who filed a Federal Income Tax Return, including the submission of W-2 forms and, if applicable, W-2 forms for a spouse in the case of a joint filing. Significantly, the form carries legal weight, indicating that the provision of false information could lead to felony charges, underscoring the seriousness with which this document and the information it solicits are regarded.

Example - Nycers F351 Form

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

Document Attributes

Fact Name Description
Form Purpose The F351 form is used annually by Tier 3 & Tier 4 Disability Retirees of NYCERS to verify eligibility for continued disability benefits by reporting any Personal Service Income.
Required Respondents All Tier 3 & Tier 4 Disability Retirees must complete this form.
Consequences of Non-Submission If the affidavit and required documents are not received, NYCERS may suspend retirement benefits until the information is provided.
Excluded Income Income from NYCERS’ Pension Checks, Social Security, Workers’ Compensation, and earnings from rental properties, stocks, bonds, IRAs, and bank account interest do not need to be reported.
Submission Requirements Along with the affidavit, copies of the Federal Income Tax Return for 2012 and W-2 forms are required unless no income was earned.
Penalty for False Statements Submitting false statements or information is a felony under The Penal Code of the State of New York, punishable by up to 4 years in prison.
Notarization Requirement The form must be signed in the presence of a Notary Public or Commissioner of Deeds, who must also sign and date the form.
Governing Law The form is governed by and must be compliant with the laws of the State of New York.

Guide to Using Nycers F351

After completing the Nycers F351 form, it's essential to follow the provided instructions closely. This form is a necessary step for Tier 3 and Tier 4 Disability Retirees to confirm their eligibility for continued benefits by disclosing any Personal Service Income received throughout the year. Failing to submit this affidavit, along with the required documents, could result in the suspension of benefits until the necessary information is provided. To ensure smooth processing, review the instructions carefully and verify that all information is accurate and complete before submission.

  1. Start by providing your pension number and the last four digits of your Social Security Number (SSN) at the top of the form.
  2. Enter your contact information including home phone number, work phone number, first name, middle initial, last name, address, apartment number, city, state, and zip code.
  3. Under section A, you will be asked two questions regarding your income in 2012. Mark 'Yes' or 'No' to indicate if you received any monies outside of the exclusions listed on the form.
  4. If you answered 'Yes' to having earned other monies, calculate your Personal Service Income for 2012. Divide this into income earned from the private sector and income earned from the public sector, placing the amounts in the indicated boxes.
  5. Next, sign and date the bottom of the first page of the affidavit. Remember, this form must be acknowledged before a Notary Public or Commissioner of Deeds.
  6. Proceed to section B on the second page. Here, indicate whether you filed a Federal Income Tax Return for 2012 and attach a copy of your Tax Return and all W-2 forms. If you are married and filed a joint return, include W-2 forms for your spouse as well. If you did not file a tax return, attach any W-2 forms you received or indicate that you have no Personal Service Income and no W-2 forms to submit.
  7. Ensure that all the required documents, as outlined in section B, are attached to your affidavit.
  8. Finally, have the form notarized. This involves signing the form in front of a Notary Public or Commissioner of Deeds, who will then complete their section of the form, including their signature, official title, and expiration date of their commission.

Before submitting the completed form and any attachments, double-check all entries for accuracy and completeness. This careful attention to detail will help avoid delays in the processing of your affidavit and ensure your benefits continue uninterrupted. Should you have any questions during the process, do not hesitate to contact the call center for assistance.

Get Answers on Nycers F351

Many retirees, especially those on disability from their public service careers, have questions regarding the NYCERS F351 form. Below, find answers to some of the most commonly asked questions.

  1. What is the NYCERS F351 form?

    The NYCERS F351 form is an affidavit that needs to be filled out annually by all Tier 3 and Tier 4 Disability Retirees. Its primary purpose is to confirm your eligibility for continued disability benefits by reporting any Personal Service Income you received throughout the year. It helps ensure that retirees adhere to the income requirements associated with their disability pension benefits.

  2. Why do I need to submit the F351 form?

    This form is crucial because it verifies whether you've received any income outside of your pension that might affect your disability benefit eligibility. If the form, along with the required documents, isn't received by NYCERS, your retirement benefits could be temporarily suspended, pending submission. It's a compliance document that keeps everything transparent and updated with NYCERS.

  3. What income needs to be reported on the F351 form?

    When filling out the F351 form, you will exclude any income you receive from your NYCERS Pension Check, Social Security, Workers' Compensation, and income earned from rental property, stocks, bonds, IRAs, and bank account interests. Thus, any income you received from personal services outside the exclusions listed needs to be reported. This includes earnings from both public and private sectors that aren’t explicitly excluded on the form.

  4. What if I did not earn any Personal Service Income?

    If you did not earn any Personal Service Income in the year you're reporting for, you would indicate this by answering "No" to the question asking if you've earned any money outside the exclusions. It's still essential to submit the form to NYCERS to ensure they have your current information and to avoid any potential suspension of your benefits.

  5. What documents must accompany the F351 form?

    If you filed a Federal Income Tax Return for the year you're reporting, you should include a copy of your tax return and your W-2 forms. If married and filed jointly, include your spouse's W-2 forms as well. If you did not file a tax return for that year but received W-2 forms, those should be included. And if you earned no Personal Service Income and therefore have no W-2 forms to submit, you should state this clearly on the form.

  6. What happens if I submit false information?

    Submitting a document with false information to NYCERS is considered a felony under the Penal Code of the State of New York. Such an action could result in up to four years of imprisonment. All documents suspected of containing false statements will be reviewed and possibly investigated further, emphasizing the importance of truthful reporting.

  7. How do I submit the F351 form?

    After filling out the form, ensure that it is notarized. This means it must be signed in the presence of a Notary Public or Commissioner of Deeds who will also sign it. You should then submit it to NYCERS along with any required documents as outlined on the form. If you have questions about submission or need further details, contacting the NYCERS Call Center at the provided phone number is advised.

Common mistakes

Filling out the NYCERS F351 form, an essential document for Tier 3 and Tier 4 Disability Retirees verifying their eligibility for continued disability benefits, necessitates careful attention to detail. Errors made during this process can lead to unnecessary delays or even the suspension of benefits. Here are eight common mistakes:

  1. **Not Reporting All Personal Service Income** - Many individuals fail to accurately report all income earned from personal services, not realizing that this includes income from both public and private sectors, excluding only specific sources outlined by NYCERS.
  2. **Overlooking the Requirement for Notarization** - The form requires notarization upon completion, a crucial step that is often missed. This acknowledgment by a Notary Public or Commissioner of Deeds is a legal necessity, ensuring the authenticity of the signature.
  3. **Failing to Include Required Tax Documents** - Submission without attached Federal Tax Return and W-2 forms, when applicable, is a common oversight. These documents are vital for verifying the reported income.
  4. **Incorrect Calculation of Personal Service Income** - When calculating personal service income, errors often occur, either by misunderstanding what constitutes personal service income or by simple calculation mistakes.
  5. **Leaving Sections Incomplete** - Skipping questions, especially in part A, where affirmation of income types is required, can lead to processing delays. Completeness ensures a smoother verification process.
  6. **Forgetting to Update Personal Information** - Inaccuracies or outdated information, such as address or phone number, can impede communication and processing, making timely updates essential.
  7. **Neglecting to Submit the Form Annually** - This form must be completed and submitted each year. Failure to do so can result in the suspension of benefits until the oversight is rectified.
  8. **Providing False Statements or Information** - Submitting any false statements or information, not only is illegal but also subject to severe penalties under New York Penal Code. Accuracy and honesty are paramount.

To avoid these common mistakes, individuals are encouraged to review their forms thoroughly before submission. Ensuring accuracy, completeness, and compliance with all requirements is essential for the maintenance of disability benefits. By paying attention to these details, retirees can help secure their financial wellbeing.

  • Checking each section for completeness and accuracy is crucial.
  • Verifying the income reported matches the required documentation prevents misunderstandings.
  • Ensuring the form is notarized helps avoid unnecessary administrative setbacks.
  • Maintaining updated personal information on the form facilitates smoother communication.

In conclusion, while the F351 form serves as a critical tool for Tier 3 and Tier 4 Disability Retirees in verifying their income and maintaining eligibility for benefits, its proper completion cannot be overstated. By avoiding these common mistakes, retirees can ensure the continued receipt of their disability benefits without interruption.

Documents used along the form

When dealing with the administration of benefits for Tier 3 and Tier 4 Disability Retirees, the NYCERS F351 Affidavit of Personal Service Income form plays a crucial role. This form is designed specifically to ascertain eligibility for continued disability benefits by documenting personal service income received throughout the year. However, completing the F351 form is often just one step in the process. There are several other documents and forms that retirees may need to gather and submit to ensure a smooth and uninterrupted benefits experience.

  • W-2 Forms: Important for almost all employment scenarios, W-2 forms report an employee's annual wages and the amount of taxes withheld from their paycheck. For the purposes of the F351 form, W-2 forms serve as essential evidence of personal service income, unless all of one's income is exempted as outlined.
  • 1040 U.S. Individual Income Tax Return: This comprehensive document is crucial for providing an overview of one’s financial status. If a retiree has filed a Federal Income Tax Return for the year in question, a copy of the 1040 form must be included to corroborate the income details entered in the F351 form.
  • Documentation of Exempted Income Sources: Since certain income types, like social security, workers’ compensation, rental income, and returns from investments, do not need to be reported on the F351, documentation proving these income sources might be necessary if there’s a need to distinguish them from personal service income.
  • Proof of Disability: While not directly related to income verification, proof of one’s disability status, possibly through medical records or an official letter from another agency verifying the disability, might be requested to maintain eligibility for disability retirement benefits.
  • Notarization Acknowledgement: This isn’t a form or document per se, but the requirement for the F351 form and certain supporting documents to be notarized underlines the need for accessing a Notary Public or Commissioner of Deeds. The act of notarization adds a level of official verification to the claim, ensuring that all statements made are confirmed by the retiree in the presence of an authorized individual.

Gathering and accurately completing these documents is key for Tier 3 and Tier 4 Disability Retirees looking to confirm their eligibility for continued benefits. While each document serves its specific purpose, together they create a comprehensive profile of the retiree’s financial and employment status. It’s important to approach this process with diligence and attention to detail, ensuring that all required information is complete and accurate to avoid any potential disruption in benefits.

Similar forms

The Form 1099-MISC is quite similar to the NYCERS F351 form in its purpose of reporting income that falls outside of regular wage earnings, specifically focusing on miscellaneous income. Both documents serve to inform respective authorities about earnings that may not typically be subject to withholding, ensuring that individuals accurately report their total income. While the F351 focuses on personal service income for disability retirees, the 1099-MISC encompasses various types of payments such as rent, prizes, and freelance work, highlighting their similar goal of comprehensive income reporting for specific purposes.

The SSA-1099 form, issued by the Social Security Administration, also shares characteristics with the NYCERS F351 form by targeting a specific demographic to report annual income, in this case, individuals receiving social security benefits. Much like the F351, which requires disability retirees to report non-pension and non-social security personal service income, the SSA-1099 helps recipients to include social security benefits in their annual income tax returns, ensuring accurate income reporting and tax liability calculation for individuals receiving federal benefits.

The W-2 form is integral for employees and employers alike, mirroring the requirement aspect seen in the F351 form. This document reports an employee's annual wages and the amount of taxes withheld from their paycheck, a necessary step for filing taxes accurately. The NYCERS F351 form, by contrast, focuses on income earned from personal services beyond the typical employer-employee relationship but similarly necessitates the inclusion of this information for proper documentation of income and verification of benefits eligibility.

The Schedule C (Form 1040) is used by sole proprietors to report income or loss from a business they operated or a profession they practiced as a sole proprietor, closely aligning with the NYCERS F351 form's aim to report personal service income. Both forms cater to individuals needing to report specific types of income that fall outside regular employment wages, demonstrating the broader responsibility individuals have to report all sources of income, perhaps from self-employment or personal services, for accurate tax and benefits assessment.

The Pension Benefit Statement, albeit not a form filed with the IRS, resembles the NYCERS F351 in its purpose of informing individuals about their pension-related income. While the Pension Benefit Statement provides a summary of pension benefits one is either receiving or entitled to receive, the F351 requires reporting of income other than pension money. Both documents, however, are pivotal for individuals to understand their financial inflow from retirement benefits and other personal service income, ensuring they have a comprehensive overview of their annual income for tax and eligibility purposes.

Dos and Don'ts

When completing the NYCERS F351 form, there are specific steps and precautions that Tier 3 and Tier 4 Disability Retirees should follow to ensure their disability benefits continue without interruption. Here is a list of things you should and shouldn't do:

  • Do thoroughly review the entire form before you start filling it out to understand what information is required.
  • Do report all Personal Service Income not excluded by the instructions, including income from both public and private sectors received during the year.
  • Do include copies of your Federal Income Tax Return for 2012 and your W-2 forms. If you filed jointly with your spouse, include their W-2 forms as well.
  • Do make sure to sign the form and have it notarized as required by the instructions on the second page.
  • Don't forget to submit this form even if you did not file a Federal Income Tax Return for 2012. If you have W-2 forms, you must attach them.
  • Don't ignore the necessity to report any changes in your Personal Service Income promptly. Delaying or omitting this information could result in the suspension of your benefits.
  • Don't overlook the legal implications of providing false information on this form. Doing so is considered a felony and is punishable by law.

Following these guidelines closely will help ensure that your benefits remain in effect and reduce the risk of legal repercussions due to omitted or falsified information on your NYCERS F351 form.

Misconceptions

There are several misconceptions about the NYCERS F351 form, especially among Tier 3 and Tier 4 Disability Retirees. It's important to understand what this form is about and what it requires to avoid any mistakes that could affect one's benefits. Here's a list of eight common misconceptions and the truth about each.

  • All income must be reported on the F351 form. This is not true. As the form specifies, income from the NYCERS pension check, Social Security, Workers' Compensation, and earnings from rental property, stocks, bonds, IRAs, and interest on bank deposits should not be reported.
  • If I don't receive the form, I don't have to submit it. This is incorrect. It is the retiree's responsibility to ensure they complete and submit the F351 form annually to report any Personal Service Income outside of the exceptions. If NYCERS doesn't receive this affidavit, retirement benefits could be suspended.
  • The form is difficult to complete. The F351 form is actually straightforward. It asks for basic personal information and details about any personal service income earned during the year that does not fall into the exempt categories.
  • Married individuals must report their spouse's income. This is only partially correct. If filing a joint tax return, a copy of the spouse's W-2 forms must be submitted along with the retiree's. However, the spouse's personal income doesn't need to be listed in the Personal Service Income section unless it pertains to the retiree's personal services.
  • Submitting a copy of the tax return is enough. If you filed a tax return, submitting a copy is necessary, but you must also list your Personal Service Income on the F351 form itself. The tax return supports the income information but does not replace the requirement to report income on the form.
  • I don't need to submit the form if I had no income. Even if you had no Personal Service Income, the form still needs to be submitted to verify your situation and ensure your benefits continue without interruption.
  • Filling out the F351 form is voluntary. Completing and submitting this form annually is mandatory for all Tier 3 and Tier 4 Disability Retirees to maintain their disability benefits. It is not optional.
  • The form must be notarized to be considered valid. Yes, this is accurate. After filling out the form, having it acknowledged before a Notary Public or Commissioner of Deeds is a necessary step to ensure its validity.

Understanding these misconceptions and knowing the facts can help ensure that the process of completing and submitting the NYCERS F351 form goes smoothly, preventing any unnecessary interruptions to your benefits.

Key takeaways

Filling out the NYCERS F351 form is an essential annual task for Tier 3 and Tier 4 Disability Retirees to ensure the continuation of their disability benefits. Key takeaways about handling this form include:

  • The necessity for all Tier 3 and Tier 4 Disability Retirees to report any Personal Service Income yearly, excluding income such as the NYCERS Pension Check, Social Security, Workers’ Compensation, and income from rental property, stocks, bonds, IRAs, and interest on bank accounts.
  • It is mandatory to submit the affidavit along with relevant documentation like the Federal Income Tax Return and W-2 forms. Failure to do so might result in the suspension of retirement benefits until the required information is provided.
  • The form must be signed and notarized, stressing the importance of the acknowledgment process in validating the document and the reported information.
  • Submitting a document that includes false statements or information is considered a felony under The Penal Code of the State of New York, highlighting the critical nature of honest reporting and the severe consequences of fraud.

Additionally, the form serves as a reminder of the importance of maintaining transparent and honest communication with NYCERS regarding income status, to ensure that disability retirees remain eligible for their deserved benefits.

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