Application for Certification of Eligibility for Waiver of Pension Contributions

For the Months of November and December, 2020

Please Note: This form is to certify eligibility for a waiver of the CPF Pension Assessment for the Two-Month Period of November and December 2020. Even if you previously certified eligibility for a waiver of the September and October assessment, you must complete this form for the extended waiver.


Because Governor Cuomo declared a disaster emergency for the whole of New York State, the CPF’s rules permit Bishop Dietsche to apply to the CPF on behalf of each parish of our Diocese that certifies to the Bishop that:
  1. as a direct result of the COVID-19 public health emergency, the ability of that parish to function has been severely impaired; and
  2. there are inadequate resources (including endowments) within that congregation to pay CPF assessments and continue to function.
Submission of the Certification Form will certify the above statements on behalf of the parish for which it is completed. Therefore, it is important that the priest in charge consult with the wardens of the parish about whether their parish can truthfully make this certification to Bishop Dietsche.
While you are in consultation about your ability to make the above certification, please also (to avoid multiple responses by your parish) decide who (the priest or a warden) will complete and submit the Certification Form.


Please email the Rev. Canon John D. Perris no later than noon on  Tuesday, September 29, 2020.  Please state your question as clearly as possible and provide the best phone number for him to use to reach you.

The Episcopal Diocese
of New York

1047 Amsterdam Avenue
New York, NY 10025
Tel: (212) 316-7400

We are sorry, but this form is now closed for submissions. If you have any questions, please contact the Rev. Canon John Perris by email at