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State Management Personnel Manual

2200 Separations and Leaves

2236 Death of Employee

These procedures have been developed to assist agencies in attending to necessary details when a State employee dies.

Throughout, the term employee means only an active State employee; i.e., one who, at the time of death, was on the payroll in any pay or leave without pay status.

It is important that these matters be addressed promptly and with sensitivity in order to provide maximum assistance to the employee's survivors. To ensure uniformity and thoroughness, we recommend that agencies designate an appropriate individual to oversee these responsibilities and
,to serve as the primary contact with the family of the deceased. Agencies are, of course, free to adapt these procedures to suit their own unique circumstances.

These procedures are divided into two parts:

  1. Procedures for all employee deaths;
  2. Additional procedures for accidental job-realted deaths;

Procedures for All Employee Deaths

This Section identifies what information concerning the deceased must be collected, describes proper notification procedures for various benefit programs and describes procedures for contact with the family of the deceased. The data collection and notification steps (Parts A & B) should be completed as quickly as possible. Part C of this Section details additional activities agencies might need to consider and adopt when formulating their internal procedures to deal with employee deaths.

  1. Data Collection
    1. Ascertain the time and date of death and the county in which death occurred. (If this information is not provided at the time of notification of the employee's death or is not avail-able from the deceased's supervisor, other sources include the funeral home, hospital, friends and relatives.)
    2. Check the deceased's personal history folder for the name of a spouse or survivor. (While it may not be possible for the agency to idtneify a designated beneficiary, it is sufficient to communicate with a responsible party.)
    3. Verify balances of unused leave accruals. Confirm that these balances reflect the final time sheet or time card.
    4. Verify salary, negotiating unit, Social Security number, retirement registration number, insurance coverage and other payroll
  2. Notification procedures
    1. Process necessary payroll transaction to remove employee from payroll. Calculate lump sum payment for accrued and unused vacation and over-time compensatory time and ensure that payment is processed. (If an employee copy of any payroll transaction is generated, be sure it is filed and not sent to deceased's home.) Place hold on any salary checks due until they can be. reissued to the appropriate survivor. (See item 8 below.)
    2. Report-employee's death to the appropriate retirement system. Prepare
      - the Notification of Death Form (RS-6082) for members of New York State Employees' Retirement System or New York State Policemen's and Firemen's Retirement System or Form RET-61.1 for members of Teachers' Retirement System. The agency may attach a cover letter to the Director of Death Benefits at either retirement system as it deems necessary. For members of other retirement systems such as Teachers' Insurance and Annuity Association/College Retirement Equities Fund (TIAA/CREF), appropriate agency procedure should be followed.
    3. Complete the Notification of Death Form (PS-150) for the Department of Civil Service Survivor's Benefit Program, specifically sections A and D. (Funding information may be obtained from the agency payroll unit or finance office.)
    4. Complete Form (PS-404) Health Insurance Transaction Form, using the code for ordinary death, and send to Employee Insurance Section, New York State Department of Civil Service.
    5. If employee was a union member, notify the appropriate local union chapter of the employee's death.
    6. If the deceased was managerial/confidential and enrolled in the life insurance plan, notify the Department of Civil Service, Employee Insurance Section. Upon receiving notification, the Employee Insurance Section will send forms to the agency personnel office, which is res-ponsible for completing a portion of them.
    7. Send an official departmental letter of condolence to the survivor. Agencies should determine the appropriate person within the organiza-tion to issue such a letter which may vary in each case.

In addition to condolences, this letter should include:

  • The name and phone number of the individual within the agency to contact in relation to employee benefit matters;
  • A copy of the brochure "Information for Survivors of New York State Employees."

  1. In this or in subsequent correspondence, the survivor should be provided with two copies of Affidavit of Death Form (AC-934), which must be completed and returned in order to have salary checks reissued to the survivor. (Acceptable alternatives for Form AC-934 are Letters Testamentary or Letters of Administra-tion.) When completed forms are received, checks are returned for reissuance in accordance with Office of the State Comptroller procedures.

  1. Other Agency Considerations
    1. Check with deceased's supervisor about any circumstances which may require special sensitivity in dealing with the survivor.
    2. Secure the deceased's personal belongings, if any, for return
      to the survivor at an appropriate time. Determine if the deceased
      had any State property and make arrangements with the survivor
      for its return.
    3. If there are no known close relatives or if one does not feel comfortable contacting the family, consider calling the funeral director to leave a desired message or to obtain necessary information. (Personal belongings and State property may also be returned through this channel.)
    4. Circulate a memorandum through the agency or appropriate offices giving notice of the death and information such as date, time, and location of calling hours and funeral services, address to which condolences may be sent and wishes of the family regarding contributions.
    5. Call at the funeral home, attend funeral and/or call on the family. This action sholld not be considered "official repre-sentation of an agency" unless specifically assigned by the agency appointing authority.
    6. Send letter to the family offering the services of a staff member as liaison for State business. If the official departmental letter of condolence has already designated a person to contact, that person may wish to send his/her own letter offering assistance.
    7. Notify departmental "Good Will" Committee, if appropriate.
    8. Clip obituary from newspaper and place in personnel file of the deceased.
    9. Determine if future payments, such as performance advancement awards, vacation exchange and workers' compensation, are due the deceased employee. If so, be sure these are addressed to the survivor and not the deceased employee.

  1. *Additional Procedures for Accidental Job-Related Deaths

This Section identifies the extra steps to take when a death results from a job-related accident or incident. Of course, the general procedures out-lined in Section I above are also applicable to such a case.

  1. File Form C-2 (Employer's Report of Injury), submitting the original to the Workers' Compensation Board and two copies to the State Insurance Fund.
  2. Complete Form PS-404, Health Insurance Transaction Form, using the code for accidental job-related death and send it to Employee Insurance Section, New York State Department of Civil Service.
  3. Administer the Accidental Death Benefit Program for deceased employees as detailed in the Governor's Office of Employee Relations Bulletin OER-86-1, dated January 22, 1986. The pro-cedure is as follows:
    1. Notify agency GOER liaison of the death of an employee that may be job-related.
    2. Advise survivor(s) of the existence of the Accidental Death Benefit and assist the survivor(s) to complete the Workers' Compensation Form C-62 (Claim for Compensation in Death Case).
    3. Telephone the Workers' Compensation Board and follow-up in writing with a request for an expedited hearing date.
    4. Upon receipt of the Workers' Compensation Board Form C-67 (Notice of Decision in Death Case) or Form C-68 or C-68A (Notice of Award in Death Casses in Which There Are No Persons Entitled to Compensation), write to Director of Board Review Bureau, Workers' Compensation Board, 180 Livingston Street. Brooklyn, NY 11248, to request a written statement verifying that no appeal has been filed against the Board's decision.
    5. Upon receipt of the letter from the Review Bureau stating that they have no appeals on file at the time, prepare and submit a special charge voucher for payment of the Accidental Death Benefit pursuant to Office of the State Comptroller Procurement and Disbursement Guidelines Bulletin G-45, dated January 14, 1986.
    6. Notify the Governor's Office of Employee Relations, Program Planning and Employee Development Group, Tuition Processing Unit, by letter with a copy of Form C-67 (Notice of Decision in Death Case) of the existence of dependents who could be-come eligible for the tuition assistance program.

  4. In the case of accidental job-related death, any Employees'
    Retirement System payment is supplemental to the Workers' Compen-
    sation Board award and the amount of such retirement payment is
    reduced by the amount of the Compensation award. In cases where
    it appears that the amount of any such retirement payment will
    be reduced pending a Workers' Compensation Board decision and the
    deceased employee was a member of the Employees' Retirement System,
    the survivor may submit an application to the Retirement System,
    pursuant to Section 61 of the Retirement and Social Security Law,
    for payment of benefits at a higher rate pending the final Workers'
    Compensation Board decision. The survivor must guarantee reim-
    bursement of movies later considered duplicate payment. The Comp-
    troller may authorize such payment pursuant to Section 64 of the
    Retirement and Social Security Law. thereby enabling the survivor
    to receive a greater fenefit at an earlier date. (The agency
    cannot submit the application under Section 61 on behalf of the

  5. The agency should provide every possible assistance to survivors in a timely manner and exercise special sensitivity in all con-tacts with them. For example, the agency head might want to send a personal letter of condolence to the family and to appoint an official delegation to attend funeral services.

TM-9; 4/1/86

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