NYSHIP Application for Enrolling Domestic Partners (PS-425)

State employees apply for enrolling domestic partners in NYSHIP and affidavit of domestic partnership.

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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:         

Human Resources
120 Crofts Hall
2020欧洲杯体育直播投注 North Campus

Form must be notarized

Need Help Completing the Form?

State Benefits

Human Resources

phone: 716-645-7777

Email: ub-hr-benefits@stpatrickshosp.com

Form Facts

Form Type: Downloadable, PDF document


Updated:  September 2019

Owner:2020欧洲杯体育直播投注 State of New York Department of Civil Service