SF 3112, Documentation in Support of Disability Retirement Application, is the package of Standard Forms that applicants for disability retirement from civilian Federal service complete for the Office of Personnel Management (OPM). It holds the applicant's statement, the supervisor's statement, the physician's statement, the agency's certification and the agency checklist. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the form is published by OPM at opm.gov.
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What is SF 3112?
Standard Form 3112, Documentation in Support of Disability Retirement Application, is the package of forms that applicants for disability retirement from civilian Federal service complete, and that the Office of Personnel Management (OPM) uses to decide whether a disease or injury is so severe that the applicant can no longer perform useful or efficient service, or requires restrictions from critical duties of the job.
The package contains five forms, each completed by a different person:
- SF 3112A, Applicant's Statement of Disability, completed by the applicant.
- SF 3112B, Supervisor's Statement, completed by the immediate supervisor or someone who regularly observes the applicant.
- SF 3112C, Physician's Statement, with Section A completed by the applicant and Section B by the physician.
- SF 3112D, Agency Certification of Reassignment and Accommodation Efforts, completed by the agency's Coordinator for Employment of the Handicapped or another authorized official.
- SF 3112E, Disability Retirement Application Checklist, completed by the employing agency.
Each form says it applies to disability retirement under the Civil Service Retirement System (CSRS) or the Federal Employees Retirement System (FERS). The package is meant to be read with the pamphlet Information About Disability Retirement, which your agency should give you. It is not the retirement application itself: the SF 3112E checklist refers to SF 2801 or SF 3107, Application for Immediate Retirement, as a separate document.
Who needs to file SF 3112?
Applicants for disability retirement from civilian Federal service use SF 3112. The cover page says the package contains the forms these applicants need to complete.
Other people complete the parts meant for them:
- Supervisor. The immediate supervisor, or someone able to observe the applicant on a regular basis, completes SF 3112B. The applicant's signature on SF 3112A authorizes the supervisor to provide the information.
- Physician. The treating physician completes Section B of SF 3112C. The applicant completes Section A and signs the consent to release medical information.
- Agency officials. The Coordinator for Employment of the Handicapped or another authorized agency official completes SF 3112D. The employing agency completes SF 3112E, which is signed by the Chief Personnel Officer or a designee.
Applicants under FERS or CSRS with offset service must also document that they applied for Social Security disability benefits (item 11 of SF 3112A). SF 3112E, item 11, asks for the name and address of the person acting for an employee who cannot act on his or her own behalf.
When to file SF 3112
OPM must receive your application not more than one year after the date you separated from your position. If you cannot get all the information requested, do not delay sending SF 3112A to OPM; the accompanying pamphlet explains the exceptions.
Medical information should contain a diagnosis, prognosis and treatment plan dated no more than 60 days before the date your application is filed. OPM accepts all medical evidence about your disease or injury, but current evidence gives the best support.
The physician is asked to complete SF 3112C within 2 weeks. If you have not separated from Federal service, your agency's personnel office assembles the package and sends it to OPM, so follow up with the agency to be sure it was sent. The form gives no processing time.
Documents you need
- Copy of your position description: put it with the forms you give your doctor(s); SF 3112C also says the applicant must attach a copy of the most current position description.
- Medical evidence with diagnosis, prognosis and a treatment plan dated no more than 60 days before the date your application is filed.
- Social Security application receipt or award notice, only if you apply under FERS or CSRS with offset service; your application cannot be completely processed without it.
- Copy of your completed SF 3112A: it must accompany the Supervisor's Statement (SF 3112B) you give your supervisor(s).
- For SF 3112B: a copy of the position description and current performance standards, and the latest performance appraisal if available.
- For SF 3112B, as applicable: supporting documentation on performance, leave use (with medical information and leave records) and conduct.
- For SF 3112D, as applicable: supporting documentation of the agency's accommodation efforts, and of non-reassignment or non-selection, such as a reassignment offer or removal notice.
- SF 2801 or SF 3107, Application for Immediate Retirement, which the SF 3112E checklist lists among the documents to be attached.
- Agency report of Federal medical examination, if one was made, as listed on SF 3112E.
How to fill out SF 3112
Collect the package and pamphlet
Make sure you have the pamphlet Information About Disability Retirement; ask your agency if you did not receive it. Keep one copy of each completed form for your records.
Identify yourself on SF 3112A
Enter your name (last, first, middle) in item 1, your date of birth as mm/dd/yyyy in item 2 and your Social Security number in item 3.
Describe your disease or injury
In item 4 fully describe each disease or injury; OPM considers only those you discuss. In item 5 describe how it interferes with your duties, attendance or conduct, and in item 6 any other restrictions on your activities.
Report accommodations and agency status
Item 7a: accommodations you requested. Item 7b: check Yes or No on whether the agency granted them and attach any explanation. Item 7c: check your current status; if you are in leave without pay or separated, describe the jobs you have performed since.
Enter dates and hospitalization
Item 8: the approximate date you became disabled for your position, as mm/yyyy. Item 9: check Yes or No for hospitalization. Item 10: the most recent hospitalization From and To dates as mm/yyyy.
Answer the Social Security questions
Item 11 is for FERS and CSRS Offset applicants only. Check Yes or No in 11a on whether you applied for Social Security disability benefits and in 11b on whether the receipt or award notice is attached.
List physicians and sign SF 3112A
Item 12: name, address and dates of treatment for each physician you plan to ask for an SF 3112C; attach a sheet for more. In item 13 sign (do not print), and enter the date as mm/dd/yyyy, daytime phone and email address.
Complete Section A of SF 3112C
Enter your name, date of birth and Social Security number in items 1 to 3. In item 4 enter the exact name and address where the physician's report goes, following the separation-date instructions beside it, then sign and date item 5.
Pass the other forms to their completers
Give SF 3112B and a copy of your SF 3112A to your supervisor, and SF 3112C with your position description to your physician. SF 3112D and SF 3112E are completed by agency officials.
Check the parts others complete
SF 3112B has Sections A to F, ending with the supervisor's certification. SF 3112D requires a checked statement in items 4 and 5 and a certification in item 7. SF 3112E, items 1 to 14, is signed by the agency's Chief Personnel Officer or designee.
Review and download the completed PDF
Check that every item of SF 3112A and Section A of SF 3112C is complete and signed. Download or print the completed PDF from FillingPDF, keep a copy and assemble the package described under How to submit.
How to submit SF 3112
There are two routes, depending on whether you have separated from Federal service.
- Not separated: return all completed forms and associated documents to your agency's personnel office. The personnel office assembles the application package and sends it to OPM, and the agency sends the originals of each form. Follow up with your agency to be sure it does.
- Separated for more than 31 days: give each form to the appropriate individual, ask that the completed forms be returned to you, assemble the package yourself and mail it to: U.S. Office of Personnel Management, Retirement Operations Center, P.O. Box 45, Boyers, PA 16017-0045.
Supervisors and agency officials return the original of SF 3112B or SF 3112D to the employee or the personnel office, give a copy to the employee, and should not send the form directly to OPM unless OPM asked them to. The physician encloses the report in a sealed envelope marked "Medical Disability - Privileged - Private" and sends it to the address in item 4 of SF 3112C, or may give it to you for delivery. Keep one copy of each completed form. The form names no fee for the application.
FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Waiting for every document before sending SF 3112A; if you cannot get all the information, do not delay submitting it to OPM.
- Submitting medical information with a diagnosis, prognosis and treatment plan dated more than 60 days before the date your application is filed.
- Leaving out the Social Security application receipt or award notice when applying under FERS or CSRS with offset service.
- Spending Social Security disability money before OPM has reduced your annuity and billed you; the overpayment must be collected.
- Giving your doctor the forms without a copy of your position description.
- Having the physician send a narrative that skips items: every item of the Medical Documentation Requirements must be answered, with "Not Applicable" where it does not apply.
- Printing your name in the signature box of SF 3112A instead of signing it.
- Having a supervisor or agency official send SF 3112B or SF 3112D straight to OPM when OPM did not ask for it.
- Separated applicants mailing the package after one year from the separation date.
Frequently asked questions
What is SF 3112?
SF 3112 is the OPM package, Documentation in Support of Disability Retirement Application, for applicants for disability retirement from civilian Federal service. It contains SF 3112A (applicant), 3112B (supervisor), 3112C (physician), 3112D (agency certification) and 3112E (agency checklist).
Who completes each part of the SF 3112 package?
You complete SF 3112A and Section A of SF 3112C. Your supervisor completes SF 3112B, your physician completes Section B of SF 3112C, an authorized agency official completes SF 3112D and your employing agency completes SF 3112E.
Where do I send the SF 3112 forms?
If you are still employed, give them to your agency's personnel office, which assembles the package and sends it to OPM. If you were separated more than 31 days ago, mail the assembled package to OPM, Retirement Operations Center, P.O. Box 45, Boyers, PA 16017-0045.
What is the deadline to file for disability retirement with SF 3112?
OPM must receive your application not more than one year after the date you separated from your position. If you cannot get all the requested information, do not delay sending SF 3112A; the accompanying pamphlet explains exceptions.
How current must my medical evidence be?
The information should contain a diagnosis, prognosis and treatment plan dated no more than 60 days before the date your application is filed. OPM accepts all medical evidence about your condition, but current evidence best supports the application.
Do I need to apply for Social Security disability benefits?
Yes, if you apply under FERS or CSRS with offset service. Attach the Social Security application receipt or award notice; OPM cannot completely process your application without it. If Social Security awards benefits, your OPM payments are reduced from the award start date.
Who pays for the physician's statement?
The applicant is responsible for any costs of providing the medical documentation, according to the SF 3112C instructions. The physician is asked to complete the statement within 2 weeks and to answer every item listed under Medical Documentation Requirements.
Can I fill out SF 3112 online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service, not affiliated with OPM, and does not submit the forms; your agency's personnel office or you send them to OPM as described above.
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