Article Guide
The NYCERS F351 form, officially titled the Affidavit of Personal Service Income, is a crucial document for individuals classified as Tier 3 or Tier 4 Disability Retirees. This form must be completed annually to ensure that retirees remain eligible for their disability benefits. The primary objective is to report any Personal Service Income earned during the year, which includes income from both public and private sectors. It is essential to note that certain types of income, such as NYCERS pension checks, Social Security benefits, Workers’ Compensation, and earnings from investments like rental properties or stocks, do not need to be reported on this form. Failure to submit the F351 form and the accompanying documentation may result in the suspension of retirement benefits until the required information is provided. Retirees are also required to submit copies of their Federal Income Tax Return and W-2 forms, reinforcing the importance of accurate and timely reporting. The form includes a series of questions to ascertain any additional income earned, and it must be signed and notarized to validate the information provided. Compliance with this process is not only a matter of maintaining benefits but also a legal obligation, as false statements can lead to severe penalties under New York State law.
Preview - Nycers F351 Form
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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
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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
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Form Characteristics
| Fact Name | Details |
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| Purpose of the F351 Form | This form is used by Tier 3 and Tier 4 Disability Retirees to report Personal Service Income and verify eligibility for continued disability benefits. |
| Submission Requirement | Retirees must complete and submit the F351 form annually. Failure to do so may result in the suspension of retirement benefits. |
| Income Reporting | Personal Service Income includes earnings from both public and private sectors, excluding pensions, Social Security, and certain other income sources. |
| Documentation Needed | Retirees must provide a copy of their Federal Tax Return and W-2 forms if they filed taxes. If no taxes were filed, W-2 forms must still be submitted. |
| Legal Consequences | Providing false information on the F351 form can lead to felony charges under the Penal Code of the State of New York, with penalties including imprisonment. |
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