This Notice is for any active, vested or retired member (retired after 9/11/01) who participated in World Trade Center (WTC) Rescue, Recovery, or Clean-up Operations between September 11, 2001 and September 12, 2002.

This is NOT an application for disability. This is a sworn statement indicating the dates and locations of your participation which preserves your right to file for disability under the W TC Disability Law. If you meet the pre-qualifying criteria under the WTC Disability Law and wish to apply for disability retirement, you must file a disability application. Please complete all of the information below, have this form notarized and return it to NYCERS.

The deadline for submission of this form is September 11, 2022. For vested members in the covered groups listed on page 4, the filing period is extended to September 11, 2022. NOTE: If the address you provide on this form is different from your address in our system, the new address will become your official address in our records.

If you have any questions, please contact our Call Center at 347-643-3000. Eligible beneficiaries of deceased members should complete this form as the members would have completed it.