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NYC Forms | FDNY Forms | UFA Forms

NYC Forms

• Information regarding NYC Health Benefits for Young Adult Dependents up to Age 29
• Change of Employee Address for LODI
• Deferred Compensation Plan Forms
• Dependent Care Assistance Program Claims
• Health Benefits Application
• Health Care Flexible Spending Account Claims
• Health Care Flexible Spending Account Qualifying Event Mid-Year Change
• Medical Spending Conversion Enrollment Change
• WTC NYS Workers Comp Retired FDNY Volunteers
• Military Repayment Plan Enrollees Prior to 12/07/2006. Form: DP-2541
• Military Repayment Plan Enrollees After 12/07/2006. Form: DP-2542

FDNY Forms

• FDNY Change of Address
• 50% Indicator
• Bereavement Leave Request
• Direct Deposit
• Emergency Leave Request
• Extra-Departmental Employment Request (EDE)
• Grievance Presentation
• I.T.H.P. Waiver
• Jury Duty Notification
• Life Insurance Fund of New York Fire Dept. Beneficiary Designation
• Military Leave Request
• Return to Duty from Vacation Leave Interrupted by Medical Leave
• Self Mutual Request
• Special Vacation Request
• Surgical Assistance Fund Application
• Vacation Leave Interrupted by Medical Leave
• WTC Disability Application for Active Members
• WTC Disability Application for Retired Members


• WTC Disability Application for Reclassification
• WTC Presumptive Illness Registration Form




UFA Forms

• 2010 Delegate Education Seminar - Sponsorship Application
• UFA Change of Address/Phone/Email Form
• Company OOS Chart List
• Catastrophic Insurance Form
• Sample CD-73 for Steampipe Explosion
• Company Out of Service Fax Form
• Coordination of Benefits Form
• Firehouse Closed Fax
• Healthplex Dental Form
• Anesthesia Claim Surgical
• Anesthesia Claim Maternity
• FirePAC
• Locker Card for Medical Leave
• Retirement & 20 Year Certificate Request
• UFA Event Volunteer List
• Newlywed Checklist
• New Baby Checklist
• Divorce Checklist




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