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Member Survey Member Login

Member Documents

General Member Forms

Pension

Disability Pension Application
Direct Deposit Authorization Form
Pension Appeal Form
Pension Application
W-4P 2021

Welfare

Medicare and You 2021
Private Health Information Authorization Form
Active City Carpenters Reimbursement Claim Form 2019
Active City Carpenters Reimbursement Claim Form 2020
Active City Carpenters Reimbursement Claim Form 2021
Retired City Carpenters Reimbursement Claim Form 2019
Retired City Carpenters Reimbursement Claim Form 2020
Retired City Carpenters Reimbursement Claim Form 2021
ASO/SIDS Dental Claim Form
Paid Family Leave- Bonding Application 2021
Paid Family Leave- Family Member Application 2021
Paid Family Leave- Self Covid-19 Related Application 2021
Paid Family Leave- Dependent Covid-19 Related Application 2021
Paid Family Leave- Military Application 2021
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

Other

NYCDCC Health Enrollment and Beneficiary Designation Form
Stop Payment Request Form
Change of Address Form
Authorization-to-Rescind-Reciprocal-Waiver
Benefit Shortage Form
Benefits Opt In Form
Disqualifying Employment Questionnaire
Reciprocal Authorization Form
Prudential Beneficiary Form
Prudential Loan Payment Sheet Coupon

 

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.