New York State and Local Retirement System (NYSLRS) Request to Purchase Service Credit (including any Military Service) (RS5042)

State employee requests to apply prior state and/or military service for NYSLRS pension service credit.

Mobile Users

For the best experience in completing this form use a non-mobile device.

Using Firefox with PDF forms?

Make Adobe Acrobat the reader.

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

Alternate Option: Complete Your Transaction Online

This transaction may be completed online. Retirement Online gives you an easy and secure way to review your benefits and conduct transactions in real time instead of sending forms through the mail or calling the Retirement System.

You can do things like update your contact information, view or update your beneficiaries, apply for a loan, request service credit, manage your loan and service credit payments, estimate your pension benefit or apply for retirement.

Need Help Completing the Form?

Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: June 2011

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