*If available from applicant. If included, certified copies required.
| Name | _________________________________ | Phone | _________________________________ |
| Personnel Specialist | |||
|
Page Created June 29, 2001
q
FEDMER Flag (Pink)q
FEDMER Statement of Participation
q SF 3107, Application for Immediate Retirement (Federal Employees Retirement System)
q SF 3112, Documentation in Support of Disability Retirement
q SF 3112A, Applicants Statement of Disability
q SF 3112B, Supervisors Statement
q SF 3112C, Physicians Statement
q SF 3112D, Agency Certification of Reassignment and Accommodation Efforts
q SF 3112E, Disability Retirement Application Checklist
q Medical Documentation
q SSA Form 3368-BK (Adult Form) - Disability Report
q SSA-827 - SSA Medical Release Form
q Birth Certificate*
q Proof of Military Service (e.g. DD214)*
*If available from applicant. If included, certified copies required.
| Name | _________________________________ | Phone | _________________________________ |
| Personnel Specialist | |||
|
|
Page Created June 29, 2001