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All data submitted using this form is encrypted for your security.

This form is to be completed by the member, NOT the employer.
Employer must notify CSEA EBF of eligibility separately.

To begin, please enter your social security number below so we can check your current enrollment status:

Enter Member's SSN:

You have entered an invalid SSN.
Please re-enter your 9 digit SSN

You have entered an invalid NYS Employee ID.
Please check the number and re-enter it below.