Employee's Retirement System (ERS) Membership Registration (RS 5420)

State employee registers into the membership of the employee retirement system.

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Completing the PDF Form

  1. Read through all pages of the document to find specific instructions if any
  2. Enter requested information into the form
  3. Print the form
  4. Get required signatures
  5. Scan a copy of the signed form for your records
  6. Send the original, completed, signed form to:         

Human Resources
120 Crofts Hall
North Campus

Form must be notarized

Need help completing the form?

Send email, phone or submit a question

Lissa Jasinowski

Retirement Administrator

State Benefit Services

Phone: (716) 645-4488

Email: lmt22@buffalo.edu

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Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: May 2013

Owner: Office of New York State Comptroller, New York State and Local Retirement System