Member Survey Member Login
Member Survey Member Login

Member Documents

General Member Forms


Disability Pension Application
Direct Deposit Authorization Form
Pension Appeal Form
Pension Application
W-4P 2020


Medicare and You 2020
Private Health Information Authorization Form
Active City Carpenters Reimbursement Claim Form 2020
Retired City Carpenters Reimbursement Claim Form 2020
ASO/SIDS Dental Claim Form
Paid Family Leave- Bonding Application
Paid Family Leave- Care for Family Member Application
Paid Family Leave- Military Application
Paid Family Leave- COVID-19 Related Application
Required Documents for Eligible Dependents
Short-Term Disability Form
Short-Term Disability Form- City Carpenters
Health Insurance Claim Form- Empire
Prescription Mail Order Form- English
Prescription Mail Order Form- Spanish
SBC Uniform Glossary


NYCDCC Health Enrollment and Beneficiary Designation Form
Stop Payment Request Form
Change of Address Form
Benefit Shortage Form
Benefits Opt In Form
Disqualifying Employment Questionnaire
Prudential Beneficiary Form
Reciprocal Authorization Form


To request any forms or documents that you do not see available on the website, please call the Benefit Funds Call Center at (800) 529-FUND (3863) or (212) 366-7373.