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New York StateUnified Court System

Broome, Chemung, Chenango, Cortland, Delaware, Madison, Otsego, Schuyler, Tioga & Tompkins Counties


New Judge Forms

*** Astericks indicate forms 6th JD newly elected judges should return to the 6th Judicial District Administrative Office. Unless otherwise noted, scanned documents are sufficient. Scanned documents may be returned to 6jdhr@nycourts.gov. Original documents should be mailed to 6th JD Administrative Office, 31 Lewis Street, Binghamton, NY 13901. Please feel free to contact the 6th JD Administrative Office HR Unit by email at 6jdhr@nycourts.gov or by phone at 607-240-5320.

(The following forms will be provided in hard copy form and/or by email: Newly Elected Judge/Justice Information, Two Oath Forms *** (Please return ORIGINAL of both to the 6th JD Administrative Office), Mentor Judge Checklist, Judicial Leave Policies)

Management/Confidential Employees - Supplemental Benefits
MC Benefits Welcome Letter / Supplemental Benefit Plan Description
Documentation Necessary to Enroll
(Return necessary documentation)***
Supplemental Benefit Plan Enrollment Application ***
Aetna Life Insurance Company Designation of Beneficiary (Return ORIGINAL)***
NYS UCS Judicial Dental Program Summary of Benefits
Dental Claim Form (for future use)
Dental Student Verification Parent Affidavit ***
Vision Care Plan Benefit Description
Davis Vision Direct Reimbursement Claim Form (for future use)

MC Life Insurance (Optional & Provided at Cost to Enrollee)
Benefit Description
Detailed Plan Information
Rate Sheet
PS-934 Instructions for Completing Form
PS-934 MC Life Application and Beneficiary Form (Will be mailed to employee, ORIGINAL must be returned even if declining coverage)***
Statement of Health (Needed if enrollment is not within six biwkly payperiods after first becoming eligible. If applicable, ORIGINAL should be mailed by enrollee to address given on form.)

Other MC Information
MC Personal Lines Insurance Program Information
AFLAC Voluntary Supplemental Insurance Program

Other
Email Policy / Internet Policy
Acknowledgment of Receipt of Email & Internet Policy***
AXA Equitable Life Insurance Payroll Notice

Judicial Pensions: Safeguarding Beneficiaries Interests
Discrimination Claim Booklet
Sexual Harassment Booklet