SF 3112 is the package of forms that the U.S. Office of Personnel Management (OPM) provides to civilian Federal employees applying for disability retirement under the Civil Service Retirement System (CSRS) or the Federal Employees Retirement System (FERS). It bundles five forms, SF 3112A through SF 3112E, which are completed by the applicant, the supervisor, the physician and the agency. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the form is published by the government at gsa.gov, and the application itself goes to OPM through the channels described below.
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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 need to complete, so that the Office of Personnel Management (OPM) can decide whether a disease or injury prevents useful and efficient service.
The package contains five forms:
- SF 3112A, Applicant's Statement of Disability, completed by the applicant.
- SF 3112B, Supervisor's Statement, completed by the immediate supervisor or someone who can observe the applicant regularly.
- SF 3112C, Physician's Statement, in which the applicant gives consent and the physician provides the medical documentation.
- 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.
The package is meant to be used with the pamphlet Information About Disability Retirement, which the agency should give the applicant. The agency sends the originals to OPM, and the applicant keeps one copy of each completed form. The forms carry OMB No. 3206-0228 and the revision date May 2011; the form states that the previous edition is usable. The package does not by itself grant retirement: OPM evaluates the evidence it collects.
Who needs to file SF 3112?
Employees and former employees applying for disability retirement from civilian Federal service use this package. That covers applicants under CSRS, under FERS, and under CSRS with offset service. Other people complete their own part:
- Applicants complete SF 3112A, sign the consent on SF 3112C (Section A) and ask their physician or physicians for the medical statement.
- Supervisors (the immediate supervisor, or someone positioned to observe the applicant on a regular basis) complete SF 3112B.
- Physicians provide the medical documentation in Section B of SF 3112C.
- Agency officials complete SF 3112D (the Coordinator for Employment of the Handicapped or another authorized official) and SF 3112E (the employing agency, signed by the Chief Personnel Officer or designee).
FERS and CSRS offset applicants must also document that they applied for Social Security disability benefits. SF 3112E, item 11, asks for the name and address of the person acting for the applicant when the applicant 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.
The medical information should contain a diagnosis, prognosis and treatment plan dated no more than 60 days before the date your application is filed. The form says current evidence gives the best support. Physicians are asked to complete the Physician's Statement within 2 weeks.
If you are still employed, your agency's personnel office assembles and sends the package, so follow up with the agency to be sure it was sent. The form sets no other deadline.
Documents you need
- A copy of your position description, given with the forms to your doctor(s); the Physician's Statement says the applicant must attach the most current position description.
- Diagnosis, prognosis and treatment plan dated no more than 60 days before the date your application is filed, from your medical evidence.
- Social Security disability application receipt or award notice, attached only if you apply under FERS or CSRS with offset service.
- A copy of the completed SF 3112A, which must accompany the SF 3112B you give your supervisor(s).
- With SF 3112B: a copy of the position description and current performance standards, and the latest performance appraisal if available.
- With SF 3112B, only where the supervisor's answers call for them: supporting documentation of performance, leave use and conduct.
- With SF 3112D: supporting documentation of the agency's accommodation efforts, or of non-reassignment or non-selection, when the boxes checked require it.
- Form SF 2801 or SF 3107, Application for Immediate Retirement, which SF 3112E lists among the documents the agency attaches.
- Agency report of Federal medical examination, if one was made, listed on SF 3112E.
- Copies of all medical reports referenced in the physician's statement, enclosed with the report in a sealed envelope.
How to fill out SF 3112
Review the package and pamphlet
Confirm you received the pamphlet Information About Disability Retirement; if not, ask your agency for it. The package holds SF 3112A to SF 3112E, and each form is completed by a different person.
Identify yourself on SF 3112A
Enter your name (last, first, middle) in item 1, date of birth as mm/dd/yyyy in item 2 and your Social Security number in item 3.
Describe your condition and its effects
Item 4: fully describe each disease or injury, since only those you discuss are considered. Item 5: describe how it interferes with your duties, attendance or conduct. Item 6: describe other activity restrictions.
Report accommodations and work status
Item 7a: list accommodations you requested. Item 7b: check Yes or No for whether your agency granted them and attach any documentation. Item 7c: check your current status; if on leave without pay or separated, describe jobs performed since.
Enter dates, hospitalization and Social Security
Item 8: approximate date you became disabled (mm/yyyy). Items 9 and 10: hospitalization, with From and To dates in mm/yyyy. Item 11 is for FERS and CSRS offset applicants only: answer 11a and 11b about the Social Security application and its receipt or award notice.
List physicians, then sign and date
Item 12: name, address and dates of treatment for each physician you plan to ask for an SF 3112C. In item 13, sign (do not print), add the date, daytime telephone number 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, give the exact name and address where the physician should send the report: your agency contact if employed or separated under 30 days, or your home address if separated 31 days or more. Sign and date item 5.
Pass SF 3112B to your supervisor
Give your supervisor SF 3112B with a copy of your completed SF 3112A. The supervisor completes Sections A to F on performance, attendance, conduct and accommodation.
Pass SF 3112C to your physician
Give the physician SF 3112C and your position description. Section B asks for medical documentation answering the numbered requirements, item by item, on the physician's letterhead.
Let the agency complete SF 3112D and 3112E
The agency official completes SF 3112D (items 1 to 7) on accommodation and reassignment. The employing agency completes SF 3112E, items 1 to 14, and checks off the attached documents.
Review, sign and download the PDF
Check every item, dates in the format printed, and signatures. Download or print the completed PDF from FillingPDF, keep one copy of each form and assemble the package as described under How to submit.
How to submit SF 3112
There are two routes, depending on whether you are still in Federal service.
- Not separated from Federal service: return all completed forms and associated documents to your agency's personnel office. The office assembles the disability retirement application package and sends it to OPM. Follow up with your agency to be sure it is sent.
- Separated for more than 31 days: give each form to the appropriate person and 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.
Other participants return their forms as follows. Supervisors and agency officials return the original to the employee or the personnel office, give the employee a copy, and should not send it directly to OPM unless OPM asks. Physicians enclose the report and any attachments in a sealed envelope marked "Medical Disability - Privileged - Private" and send it to the address in item 4 of SF 3112C, or give it to the applicant to deliver. The applicant is responsible for any costs of providing the medical documentation.
Keep one copy of each completed form. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Leaving out the Social Security disability application receipt or award notice when applying under FERS or CSRS offset; the application cannot be completely processed without it.
- Spending Social Security disability money before OPM has reduced your annuity and billed you for any overpayment; OPM is required by law to collect it.
- Giving the physician no copy of your position description; the Physician's Statement says it must be attached.
- Submitting medical evidence with a diagnosis, prognosis and treatment plan dated more than 60 days before the filing date.
- Describing only some conditions on SF 3112A; OPM considers only the diseases and injuries you discuss in the application.
- Printing your name instead of signing item 13 on SF 3112A, which says "Signature (Do not print)", or signing the SF 3112C consent without a date.
- Having the supervisor or agency official mail SF 3112B or SF 3112D directly to OPM when OPM has not requested it.
- Letting the one-year limit pass after separation because you waited for every form; send SF 3112A to OPM instead of delaying.
- Sending a physician's report that skips items; unanswered items should say "Not Applicable", and incomplete information delays processing.
Frequently asked questions
What is SF 3112 used for?
SF 3112 is the OPM package of forms for civilian Federal employees applying for disability retirement under CSRS or FERS. It gathers the applicant's statement, the supervisor's statement, the physician's statement and the agency's certification so OPM can decide whether the condition prevents useful and efficient service.
What forms are included in SF 3112?
Five forms: SF 3112A (Applicant's Statement of Disability), SF 3112B (Supervisor's Statement), SF 3112C (Physician's Statement), SF 3112D (Agency Certification of Reassignment and Accommodation Efforts) and SF 3112E (Disability Retirement Application Checklist).
What is the deadline to apply 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 information, send SF 3112A anyway rather than delaying; the accompanying pamphlet explains the exceptions.
Where do I send SF 3112?
If you are still employed, return the forms to your agency's personnel office, which sends the package to OPM. If separated more than 31 days, mail it to U.S. Office of Personnel Management, Retirement Operations Center, P.O. Box 45, Boyers, PA 16017-0045.
Do I need to apply for Social Security disability benefits too?
Yes, if you apply under FERS or under CSRS with offset service. Attach the Social Security application receipt or award notice; OPM cannot completely process your application without it. SF 3112A item 11 and SF 3112E item 7 ask about it.
How old can the medical evidence be?
The diagnosis, prognosis and treatment plan should be dated no more than 60 days before the date your application is filed. OPM accepts all medical evidence about your condition, but says current evidence provides the best support.
Who fills out each part of SF 3112?
You complete SF 3112A and Section A of SF 3112C. Your supervisor completes SF 3112B, your physician completes Section B of SF 3112C, and the agency completes SF 3112D and SF 3112E. The physician is asked to respond within 2 weeks.
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; you deliver them through your agency or to OPM as described above.
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