How to Fill Out and Submit the New York Exemption Claim Form

The New York Exemption Claim Form is the one-page court document you use to tell your bank and the creditor that money frozen in your account is legally protected from seizure. You have 20 calendar days from the postmark on the envelope your bank used to mail you the notice to complete two copies, send one to the creditor or creditor’s attorney, and send the other back to the bank.¹ Miss that window and the frozen funds can be turned over to the creditor or a city marshal.

What You Received in the Mail

When a creditor with a money judgment serves a restraining notice on your bank, the bank freezes your account and mails you a packet within two business days. Inside you’ll find a copy of the restraining notice, an exemption notice explaining your rights, and two blank Exemption Claim Forms.¹

The creditor’s attorney is required to pre-fill two spots on each form before the bank forwards it: “Address A” (the creditor or attorney) and “Address B” (the bank). Those are the return addresses you’ll use, so you don’t have to track them down.

Save the envelope. The postmark on it starts every clock in this process, including your 20 days to respond. If the packet sat in your mailbox for a week before you opened it, you’ve already lost a week.

How to Fill Out the Form

You’re signing under penalty of perjury, so take it one section at a time.

Case caption at the top: Court, county, plaintiff/petitioner, defendant/respondent, and index number. Copy this exactly from the restraining notice you received.
Exempt income checkboxes: Check every box that describes money in the account, not just the main one. The categories listed on the form are Social Security, Social Security disability, SSI, public assistance, wages received while on SSI or public assistance, veterans benefits, unemployment insurance, pension and retirement account payments, income earned in the last 60 days (90 percent of which is exempt), child support, spousal support or maintenance, workers’ compensation, railroad retirement or black lung benefits, and an “Other” line for anything else that’s protected.¹
Mailing address: Fill in an address you actually check. If the creditor files an objection, motion papers come there.
Signature and date: Sign and date both copies. An unsigned form does nothing for you.

If your account holds, say, a Social Security deposit and a pension payment, check both boxes. The more sources you identify, the less room the creditor has to argue some portion of the balance is fair game.

Which Income Counts as Exempt

The categories on the form track New York’s protections under CPLR Section 5205 and the Exempt Income Protection Act. A quick guide to what fits where:

Government Benefits

Social Security retirement and disability, SSI, public assistance, veterans benefits, unemployment insurance, workers’ compensation, and railroad retirement or black lung benefits are fully protected from collection.² Child support and spousal support you receive are also protected.

Wages Earned in the Last 60 Days

Ninety percent of wages or salary earned within the last 60 days is exempt.³ The remaining 10 percent can only be reached if a court finds you don’t need it for basic living expenses. Check the “Income earned in the last 60 days” box for this.

Retirement Payments

Distributions from pensions, 401(k)s, 403(b)s, and IRAs that have been deposited in your account are covered under the pension and retirement checkbox.

Supporting Documents to Include

The form asks you to attach proof, and doing so can speed everything up. When the creditor sees clear documentation that the funds are exempt, they’re supposed to instruct the bank to release the account within seven days rather than waiting out the full eight-day objection window.⁴

Award letters from Social Security, SSI, VA, unemployment, or workers’ compensation showing the benefit type and amount.
At least two months of bank statements showing direct deposits from benefit agencies, pension administrators, or your employer. Highlight the relevant lines.
Recent pay stubs if you’re claiming the 90-percent wage exemption.
Pension or retirement distribution notices.

If your account mixes protected and unprotected money, the statements become even more important. The law requires the creditor to use what’s called the lowest intermediate balance principle to figure out how much of the current balance is still exempt, and that calculation runs on your deposit and withdrawal history.⁴ Without statements, no one can run it in your favor.

Where to Send the Completed Forms

One copy goes to Address A (the creditor or creditor’s attorney), one goes to Address B (the bank). Both addresses are already printed on the form. You can deliver them in person or send them by first-class mail.⁴

The deadline is 20 calendar days from the postmark on the bank’s envelope, not 20 business days. If you mail the forms, pay for a certificate of mailing at the post office. You get a stamped receipt showing the date you sent them, which is the date that starts the creditor’s clock to respond. That proof matters if there’s any later dispute about timing.

What Happens After You Send It

The Eight-Day Release

Once the bank gets your completed form, the restraint is treated as void eight days after the postmark on your envelope (or the date you hand-delivered it), and the bank must release the funds, unless the creditor files an objection within those eight days.⁴ In most cases where you’ve documented everything, that’s the end of it.

If the Creditor Objects

A creditor who disputes your claim has to file a motion under CPLR 5240 and serve the papers on both you and the bank within those eight days.⁴ A hearing gets scheduled for seven days after service. During this stretch the bank keeps the claimed funds on hold for up to 21 days; if the 21 days pass without a court order, the money is released to you.

Bring everything to the hearing: two or more months of bank statements, award letters, pay stubs, pension distribution notices, anything showing where the money came from. If the judge agrees the funds are exempt, the court orders the bank to lift the restraint immediately.

Protections That May Already Be in Place

Some of your money is shielded automatically, without any paperwork from you. Under the Exempt Income Protection Act, your bank cannot freeze funds below a set threshold at all. For 2026, that minimum is $4,080 if you live in New York City, Long Island, or Westchester, and $3,840 elsewhere in the state.⁵ If your balance is above the threshold, the bank still has to leave at least that amount available to you.

Separately, if you receive federal benefits by direct deposit (Social Security, SSI, VA, civil service retirement, military survivors’ benefits, railroad retirement, or FEMA disaster assistance), federal rules under 31 CFR Part 212 require your bank to automatically protect two months’ worth of those deposits before applying any garnishment.⁶ The bank looks back at the two months before the restraint, totals the federal benefit deposits, and keeps that sum (or the current balance, whichever is lower) available to you.⁷

These automatic protections don’t cover everything on the form. Pensions, wages, child support, and unemployment deposits generally require you to file the Exemption Claim Form, and the form is also the only way to challenge a freeze on amounts above the automatic thresholds. If any of your money sits in one of those categories, or your balance exceeds the automatic minimum, fill out the form and send it back.

1
New York State Senate. New York Code CVP – Service of Notices and Forms and Procedure for Claim of Exemption
2
New York State Senate. New York Code CVP – Personal Property Exempt From Application to the Satisfaction of Money Judgments
3
New York State Senate. New York Code CVP 5205 – Personal Property Exempt From Application to the Satisfaction of Money Judgments
4
New York State Senate. New York Code CVP 5222-A – Service of Notices and Forms and Procedure for Claim of Exemption
5
New York State Attorney General. Funds Protected Against Debt Collection
6
eCFR. Garnishment of Accounts Containing Federal Benefit Payments
7
Department of the Treasury / Bureau of the Fiscal Service. Guidelines for Garnishment of Accounts Containing Federal Benefit Payments