Every year, Tier 3 and Tier 4 Disability Retirees are tasked with a critical responsibility - to complete the NYCERS F351 form, an Affidavit of Personal Service Income. This procedure is not merely bureaucratic but a gateway ensuring the continuity of their disability benefits. It serves a dual purpose; it verifies the retiree's income sources for the year and confirms their eligibility for ongoing benefits. The form differentiates between multiple income types, highlighting personal service income, which is pivotal for assessment. Exclusions are clearly stated, signifying that income from the NYCERS pension, Social Security, workers' compensation, and specific investment returns do not need to be reported. Furthermore, the process underlines the necessity of accuracy and honesty, with failing to provide the affidavit potentially leading to suspended benefits until compliance is achieved. Submission is twofold – involving the affidavit itself and corresponding documents such as a federal tax return and W-2 forms, varying upon the retiree's filing status. Each step of this process underscores the importance of transparency and adherence to legal requirements, safeguarding the retiree's benefits and maintaining trust within this system. Misrepresentation is dealt with sternly, pointing to the seriousness with which this affidavit is regarded. Thus, the NYCERS F351 form represents more than just paperwork; it is a yearly affirmation of one’s financial integrity and eligibility for continued support during retirement.
| Question | Answer |
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| Form Name | Nycers Form F351 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | 351 f351 form 2011 |
NYCERS USE ONLY |
F351 |
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*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
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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:
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(income earned from the private sector)
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(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 |
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B. If you filed a Federal Income Tax Return for 2012, you must submit a copy of your Tax Return and your
you are married and filed a joint return, you must also submit a copy of your spouse's
I am including with this affidavit, the following:
A copy of my Federal Tax Return for the year of 2012 and my
I did not file my Federal Tax Return for the year of 2012 but I have attached my
I did not file my Federal Tax Return for the year of 2012 and I have 0.00 Personal Service Income and no
To verify my eligibility for continued benefits, I have included the required documents with this affidavit.
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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
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me to be the individual described in and who executed the foregoing instrument, and he or she acknowledged to me that he or she
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Sign this form and have it notarized, THIS PAGE
R11/16/12 |
Page 2 of 2 |