Form F233 "Agency-To-Agency Transfer Notification" - New York City

What Is Form F233?

This is a legal form that was released by the New York City Employees' Retirement System - a government authority operating within New York City. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2017;
  • The latest edition provided by the New York City Employees' Retirement System;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form F233 by clicking the link below or browse more documents and templates provided by the New York City Employees' Retirement System.

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Download Form F233 "Agency-To-Agency Transfer Notification" - New York City

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F233
NYCERS USE ONLY
*233*
Mail completed form to:
30-30 47th Avenue, 10th Fl
Long Island City, NY 11101
Agency-to-Agency Transfer Notification
This form is to be completed by any agency to notify NYCERS when a new employee who is ALREADY a NYCERS member has
transferred from: (1) Any New York City agency; (2) New York City Transit or MTA Bridges and Tunnels; (3) any facility of the New
York City Health and Hospitals Corporation; or (4) any campus of the City University of New York. This will ensure that the
appropriate pension payroll deductions continue to be deducted from your employee’s paycheck. Thank you for helping us keep our
member records accurate by submitting this information to NYCERS.
THIS FORM MUST BE COMPLETED BY THE AGENCY ONLY
EMPLOYEE INFORMATION
NYCERS Member Number
Last 4 Digits of SSN
Employee ID
Current Salary
First Name
M.I.
Last Name
Address
Apt. Number
City
State
Zip Code
AGENCY INFORMATION
CURRENT Agency
Agency Bank Number
Date of Appointment
Title
Title Code
[MM/DD/YYYY]
/
/
Personnel/Benefits Representative
Phone Number
E-mail Address
(
)
Employee's FORMER Agency
Signature of Personnel/Benefits Representative
Date
R02/17
Page 1 of 1
F233
NYCERS USE ONLY
*233*
Mail completed form to:
30-30 47th Avenue, 10th Fl
Long Island City, NY 11101
Agency-to-Agency Transfer Notification
This form is to be completed by any agency to notify NYCERS when a new employee who is ALREADY a NYCERS member has
transferred from: (1) Any New York City agency; (2) New York City Transit or MTA Bridges and Tunnels; (3) any facility of the New
York City Health and Hospitals Corporation; or (4) any campus of the City University of New York. This will ensure that the
appropriate pension payroll deductions continue to be deducted from your employee’s paycheck. Thank you for helping us keep our
member records accurate by submitting this information to NYCERS.
THIS FORM MUST BE COMPLETED BY THE AGENCY ONLY
EMPLOYEE INFORMATION
NYCERS Member Number
Last 4 Digits of SSN
Employee ID
Current Salary
First Name
M.I.
Last Name
Address
Apt. Number
City
State
Zip Code
AGENCY INFORMATION
CURRENT Agency
Agency Bank Number
Date of Appointment
Title
Title Code
[MM/DD/YYYY]
/
/
Personnel/Benefits Representative
Phone Number
E-mail Address
(
)
Employee's FORMER Agency
Signature of Personnel/Benefits Representative
Date
R02/17
Page 1 of 1