Acknowledgement New York State Board printable pdf download

UCS-49 (rev. 9/2013)

NOTICE OF RIGHT TO MEMBERSHIP IN A PUBLIC RETIREMENT SYSTEM

The State of New York Unified Court System is a participating employer in the New York State Employees’

Retirement System (NY ERS) and the New York State Voluntary Defined Contribution Program (NYS VDCP).

NYS ERS

Membership is only optional for persons holding provisional, temporary, part-time or seasonal positions. For all

other employees who are not eligible for NYS VDCP, or who do not elect to join the NYS VDCP, membership

in NYS ERS is mandatory.

NYS VDCP

Only employees hired after July 1, 2013, who are unrepresented and earn an annual salary of $75,000 or more

are eligible for the NYS VDCP. Membership is optional, however, an irrevocable decision must be made within

30 days from your date of appointment. Employees who are ineligible or do not elect to join VDCP are subject

to the rules for NYS ERS as noted above.

If you wish to join either NYS ERS or NYS VDCP, you must file an application for membership and you will be

required to contribute a percentage of your salary based on your annual wages. Applications for NYS ERS are

available from your administrative office. If you have any questions regarding NYS ERS membership

requirements, call the NYS ERS at (866) 805-0990 or (518) 474-7736. To enroll in NYS VDCP, visit their

website at For questions regarding the NYS VDCP, call Retirement@Work at (866) 271-0960.

ACKNOWLEDGEMENT

I, ________________________________________________ do hereby acknowledge receipt of notice of the

(Employee Name)

right to membership in a public retirement system.

_____ I intend to join the New York State Employees’ Retirement System (NYS ERS)

_____ I do not intend to join the New York State Employees’ Retirement System (NYS ERS)

_____ I intend to join the Voluntary Defined Contribution Program

_____ I do not intend to join the Voluntary Defined Contribution Program

__________________________________________________

_________________________

Employee Signature

Date

Return signed form to:

NYS Board of Law Examiners

254 Washington Ave Ext

Corporate Plaza - Building 3

Albany, NY 12203

ATTN: Employmnet Verification

A COPY OF THE SIGNED UCS-49 IS TO BE FILED IN THE EMPLOYEE’S PERSONNEL FOLDER.

_________________________

______________________________

Date Received

Payroll Agency

Acknowledgement New York State Board