Active Member Forms & Resources
Security Benefit Fund
Active Member Forms and Resources
Compensation Forms
Employment Forms
HEALTH AND SAFETY
Health & Safety Forms & Info
- Apparatus Accident Procedures
- CD-73 Narratives
- Company Out of Service Form
- FDNY Radio Codes
- Locker Card for Medical Leave
- "No Gear Beyond This Point!" Poster
- Out-Of-Battalion Detail Form
- Starting Tour Understaffed Form
Health & Safety Programs
IAFF Forms
Leave Request Forms
Military Forms & Info
NYC Fire Pension Forms
- NYC Fire Pension Fund Change of Address Form
- NYC Fire Pension Fund Check Affidavit
- NYC Fire Pension Fund Electronic Fund Transfer Form
- NYC Fire Pension Fund - Life Insurance Fund Beneficiary Form
- NYC Fire Pension Fund Manual
- NYC Fire Pension Fund Retirement Checklist
- NYC Fire Pension Fund Service Retirement & Terminal Leave Application
- NYC Fire Pension Fund Telephone Directory
- NYC Fire Pension Fund Tier II Vesting Info
- NYC Fire Pension Fund Tier III Vesting Info
- NYC Fire Pension Fund Vested Application
- NYC Fire Pension Fund W-4P Form
UFA Forms
WTC Forms & Info
- WTC Application Addendum
- WTC Disability Application
- WTC Disability Application for Reclassification
- WTC Counseling Services
- WTC Health Impacts
- WTC Pharmacy Benefit Manager
- WTC Physical Health Satellite Locations
- WTC Prescription Plan Fact Sheet
- WTC Medical Monitoring
- WTC Notice of Participation
- WTC Presumptive Illness Registration Form
- WTC Workers Compensation
Security Benefit Fund Forms & Info
Beneficiaries & Enrollment
- Change of Address Form
- Domestic Partner Update - 2023
- Active Beneficiary Enrollment Card
- View the Beneficiary Enrollment Card first to make sure you have all necessary information before entering the DocuSign form linked above. Click here to PREVIEW the Active Beneficiary Enrollment Card
- Life Insurance, Designation of Beneficiary
Health Benefits Program
All members are advised that the City Transfer Period for the Health Benefits Program will run from November 1st – November 30th. This transfer period applies to both active and retired members. Health plan changes requested during this transfer period will become effective January 1, 2025. During the annual transfer period, members may transfer into any health plan for which they are eligible, add or drop the Optional Rider, and add or drop dependent(s). Members are reminded to update their dependents during this time.
Dental
Effective January 1, 2024, UFA Members will receive dental coverage through MetLife
The MetLife Dental Changeover Period is now open, running from Nov 1 – Nov 30. During this time, members can switch between the Dental HMO (Managed Care Plan) and Dental PPO (PDP Plan) plans, with changes becoming effective January 1, 2025. To change your MetLife dental plan, please email the Security Benefit Fund at SBFStaff@ufanyc.org. Be sure to indicate what plan you would like to change over to in your email.
Medical
- Anesthesia Claim - Surgical
- Anesthesia Claim - Maternity
- Dependent Care Assistance Program Details
- GHI Urgent Care Participating Providers 2023
- Health Care Flexible Spending Account Claim
- Health Care Flexible Spending Account Qualifying Event Change
- Life Insurance, Designation of Beneficiary
- Surgical Assistance Fund Application
- Surgical Assistance Fund Fee Rates
- Surgical Assistance Fund Summary of Benefits
Optical
Active UFA Members (and their eligible spouse/dependents) can submit a claim once a year. The UFA allows active members to claim up to $130 for optical benefits per calendar year. See UFA SBF Optical Benefits for more details.
Prescriptions
Proby Enrollment
- Proby Class Intro
- Active Beneficiary Enrollment Card
- SBF Conditional Benefits (only applicable if original enrollment is incomplete)