Active Member Forms & Resources
Security Benefit Fund
Active Member Forms and Resources
FDNY Forms
HEALTH AND SAFETY
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 Virtual Retirement Seminar Schedule 2026
- NYC Fire Pension Fund W-4P Form
OLR / NYC Links & Resources
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
SBF Checklist
Our newly updated SBF Checklist can be used as a guide for all members adding or removing dependents and/or beneficiaries to ensure all proper offices are updated for Newlyweds, Domestic Partnerships, New Babies and Divorces.
Benefits / Beneficiaries / Enrollment
Make sure you have all necessary information before entering the DocuSign form linked here! This includes all social security numbers and dates of birth for all of your dependents (spouse/domestic partner and/or children/s).
Health Benefits Program
- NYC Health Benefits Program Homepage
- NYC Health Plans
- Health Benefits 2025 Open Enrollment & January 2026 Updates- Active
- Health Benefits Application for Active Members
- NYC & MLC New Health Plan: The automatic transition to the NYCE PPO plan applies only to active city employees and pre-Medicare retirees currently enrolled in the GHI Comprehensive Benefits Plan. Retirees enrolled in Medicare will see no change to their coverage; Medicare plans remain completely unaffected by this agreement. The only exception involves covered dependents of Medicare recipients. If a dependent is currently enrolled in GHI, that dependent will be automatically transitioned to the NYCE PPO plan.
Dental
Effective January 1, 2024, UFA Members receive dental coverage through MetLife
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)