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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 Form 2019
Retirement and Pension Plan Officers and Employees of NYCDCC Beneficiary Form

Welfare

Medicare and You 2019
Private Health Information Authorization Form
Active City Carpenters Reimbursement Claim Form 2019
Retired City Carpenters Reimbursement Claim Form 2019
ASO/SIDS Dental Claim Form
Paid Family Leave- Bonding Application
Paid Family Leave- Care for Family Member Application
Paid Family Leave- Military Application
Health Plan Enrollment Form
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

Stop Payment Request Form
Change of Address Form
Authorization-to-Rescind-Reciprocal-Waiver
Benefit Shortage Form
Benefits Opt In Form
Disqualifying Employment Questionnaire
NYCDCC Beneficiary Designation Form
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.