Forms & Resources
Access important forms, reimbursements, leave applications, retirement resources, and member benefits information for Local 1070 members.
Most forms are PDF documents and may open in a new tab. If you have questions about a form or benefit, please contact Local 1070.
đź©ş Health & Benefits
Reimbursement forms, wellness benefits, and health-related member resources.
Prescription Drug Copay Reimbursement
Reimbursement form for eligible prescription drug copay expenses for active members and retirees.
Optical Reimbursement
Important: The DC 37 Optical Reimbursement Claim Form and the Local 1070 Direct Optical Reimbursement Form should be completed and submitted together. Members may be eligible for up to $250 through the DC 37 optical benefit (every two years) and up to $300 through the Local 1070 Direct Optical Reimbursement benefit (annually).
Completed forms and supporting documentation may be submitted by mail to:
DC 37 Health & Security Plan – Optical Unit
125 Barclay Street
New York, NY 10007
By email: Optical@DC37.net
By fax: (212) 815-1218
Dental Claim Form
Dental claim forms and reimbursement information for eligible DC 37 members.
Premium Contribution Reimbursement
Reimbursement form for eligible NYSHIP health insurance premium contributions.
Medical Screening Benefit
Information regarding preventive medical screening services available through Inner Imaging.
Hearing & Audiology Benefits
Eligible active members and retirees may receive annual audiology evaluations, hearing aid evaluations, and basic hearing aids every three years through the DC 37 Health Center.
Appointments: (212) 791-2126
Hours: Monday–Friday, 9:00 AM–5:00 PM
Location: DC 37 Health Center, 115 Chambers Street, New York, NY 10007
Lost or Stolen Drug ID Card Affidavit
Affidavit form for requesting replacement of a lost or stolen prescription drug identification card.
Tuition Reimbursement
Tuition reimbursement information, applications, FAQs, and supporting forms are available through the DC 37 Education Fund.
Welfare Fund Enrollment Forms
Enrollment and eligibility forms for DC 37 Health & Security Plan benefits.
Change of Status Form
Form for updating dependent, spouse, domestic partner, or other eligibility and enrollment information for DC 37 Health & Security Plan benefits.
Mental Health Benefits Through NYSHIP / The Empire Plan
Members enrolled in NYSHIP’s Empire Plan have access to mental health and behavioral health services through Carelon Behavioral Health.
- Search for in-network therapists and psychiatrists
- Review behavioral health benefits
- Find providers accepting new patients
Many outpatient mental health visits are covered with a $25 copay under the Empire Plan.
Leave & Disability
đź“‹ Leave & Disability
Leave applications, sick leave bank forms, return-to-work certifications, and disability-related resources.
Sick Leave Bank Application
Application form for participation in the UCS Sick Leave Bank program.
Workers’ Compensation Resources
Forms and information related to workplace injuries and workers’ compensation claims.
UCS-48 Leave Application Instructions
Instructions for completing UCS leave request and leave-related paperwork.
Short-Term Disability
Forms and instructions for filing a short-term disability claim.
Return to Work Provider Certification
Medical provider certification form for employees returning to work.
FMLA Forms
Family and Medical Leave Act forms and related documentation.
Estimated Physical Capabilities Form
Medical evaluation form used to document physical capabilities and return-to-work restrictions.
đź’Ľ Employment & Personnel
Payroll, reassignment, reclassification, and workplace-related forms.
đź‘Ą Retirement & Pension
Retiree benefits, pension-related forms, and retirement resources for members.
Payroll Discrepancy Form
For state members to report discrepancies in their pay.
Voluntary Reassignment
For eligible state members requesting reassignment or transfer to another court or location.
Discrimination Claim
Information and forms related to discrimination complaints within the New York State Unified Court System.
Reclassification Review
Request materials and reference information related to position reclassification within the New York State Unified Court System.
Eligible List Change of Location Preference
For eligible list candidates who need to update their preferred work locations.
Voluntary Change in Assignment
For state members requesting a change in assignment under the collective bargaining agreement.
Exposure Incident Report
Forms and reporting materials related to workplace exposure incidents within the New York State Unified Court System.
Municipal Employees Housing Program
Housing assistance application and program information for eligible municipal employees.
Pension Resources
Pension information and retirement system resources for Local 1070 members.
Pension Loan Application
Loan application materials for eligible NYSLRS members in Tiers 3, 4, 5, and 6.
Deferred Compensation
Supplemental retirement savings resources through the NY State Deferred Compensation 457(b) Plan.
Beneficiary Form
Form for updating beneficiary designation information for eligible member benefits.