Terminal or Grave Illness Notification

Complete this form only if you are terminally or gravely ill and need to apply for a Disability benefit, or if you have already applied and need to notify NYCERS of the gravity of your illness.

Terminal or Grave Illness Notification

Contact Information

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Mobile Number(Required)

Disability Information

Have you applied, or are you planning to apply for a Disability benefit?

Yes

Do you have medical documentation to the extent of your illness? If you answer "No" to this question, you will need to provide Medical Evidence and other documents before NYCERS can begin processing your case.

Yes