Employee's Retirement System (ERS) Reinstate Former Tier 1 or 2 Membership (RS 5506)

Active employee applies to be reinstated to Tier 1 or 2 membership of Employees' Retirement System (ERS).

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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:         

Employees’ Retirement System
110 State Street
Albany, New York 12244-0001

Complete pages 1 and 4 of this form. Pages 2 and 3 provide a comparison of benefits for members covered under regular plans.

If you have questions call the Information Office toll free at 1-866-805-0990, in Albany area at 474-7736 or by email at

nyslrsinfo@osc.state.ny.us

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: 8/2013

Owner: Employee's Retirement System