Member Survey Member Login
Member Survey Member Login

Member Documents

General Member Forms

Pension

Disability Pension Application
Direct Deposit Authorization Form
Pension Appeal Form
Pension Application
W-4P 2024

Welfare

Medicare and You 2024
Private Health Information Authorization Form
Active City Carpenters Reimbursement Claim Form 2023
Active City Carpenters Reimbursement Claim Form 2024
Retired City Carpenters Reimbursement Claim Form 2023
Retired City Carpenters Reimbursement Claim Form 2024
Dental Claim Form- Empire
Provider Nomination Form- Dental
Independence Administrators- Coordination of Benefits
Independence Administrators- Medical Claim Form
Paid Family Leave- Bonding Application
Paid Family Leave- Family Member Application
Paid Family Leave- Self Covid-19 Related Application
Paid Family Leave- Dependent Covid-19 Related Application
Paid Family Leave- Military Application
Required Documents for Eligible Dependents
Short-Term Disability Form
Short-Term Disability Form- City Carpenters
Prescription Mail Order Form- English
Prescription Mail Order Form- Spanish
SBC Uniform Glossary

Other

NYCDCC Health Enrollment and Beneficiary Designation Form
Stop Payment Request Form
Change of Address Form
Authorization-to-Rescind-Reciprocal-Waiver
Benefit Shortage Form
Benefits Opt In Form
Disqualifying Employment Questionnaire
Reciprocal Authorization Form
Empower/Prudential Beneficiary Form
Empower/Prudential Loan Payment Sheet Coupon
NYCDCC Member Portal User Guide

 

To request any forms or documents that you do not see available on the website, please call the Benefit Funds Call Center at (800) 529-FUND (3863) or (212) 366-7373.