New York State and Local Retirement System (NYSLRS) Application to Reinstate a Former Membership (RS 5506)

Active employee applies to be reinstated to membership of the New York State and Local Retirement System (NYSLRS).

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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:         

New York State and Local 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

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Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: 8/2013

Owner: Employee's Retirement System