SF3112, Documentation in Support of Disability Retirement Application, is the package of forms that the Office of Personnel Management (OPM) provides to applicants for disability retirement from civilian Federal service. It holds five forms, SF 3112A through SF 3112E, completed by the applicant, the supervisor, the physician and the employing agency. On FillingPDF you can fill out the form online and download or print the completed PDF; the official PDF is published by OPM, and the application itself goes to OPM through your agency or directly, as described below.
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What is SF 3112?
Standard Form 3112, Documentation in Support of Disability Retirement Application, is the OPM package of forms that applicants for disability retirement from civilian Federal service complete to give OPM the evidence it needs to decide the application. It carries OMB No. 3206-0228.
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 regularly observes the applicant.
- SF 3112C, Physician's Statement, whose Section A is completed by the applicant and Section B by the physician.
- SF 3112D, Agency Certification of Reassignment and Accommodation Efforts, completed by the Coordinator for Employment of the Handicapped or another authorized agency official.
- SF 3112E, Disability Retirement Application Checklist, completed by the employing agency.
The forms apply to disability retirement under the Civil Service Retirement System (CSRS) or the Federal Employees Retirement System (FERS). The package expects you to have received the pamphlet Information About Disability Retirement. OPM must be able to conclude that the disease or injury is so severe that you can no longer perform useful or efficient service, or that a medical condition requires restrictions from critical duties of the job. The package supports an application; it is not the retirement application forms SF 2801 or SF 3107 named on the checklist.
Who needs to file SF 3112?
The main group is applicants for disability retirement from civilian Federal service. Each form in the package has its own person who completes it.
- The applicant completes SF 3112A and Section A of SF 3112C, and gives each form to the right person.
- The supervisor completes SF 3112B. It should be the immediate supervisor or someone in a position to observe the applicant on a regular basis.
- The physician completes Section B of SF 3112C.
- The Coordinator for Employment of the Handicapped or another authorized agency official completes SF 3112D.
- The employing agency completes SF 3112E, and its Chief Personnel Officer or designee certifies it.
Applicants under FERS, or under CSRS with offset service, must also document that they have applied for Social Security disability benefits. Item 11 of SF 3112A applies to FERS and CSRS Offset applicants only.
If the applicant is unable to act on his or her own behalf, item 11 of SF 3112E asks the agency to give the name and address of the person acting for the applicant. The package does not say who else may sign SF 3112A.
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 the forms request, do not delay sending SF 3112A to OPM; the accompanying pamphlet explains exceptions.
Timing for the supporting evidence is also set out. The diagnosis, prognosis and treatment plan you submit should be dated no more than 60 days before the date your application is filed. The physician is asked to complete SF 3112C within 2 weeks. If you are still employed, your agency's personnel office assembles the package and sends it to OPM; if you have been separated for more than 31 days, you assemble and send it yourself. The package sets no processing time.
Documents you need
- A copy of your position description, to give with the forms you hand your doctor(s); SF 3112C also says the applicant must attach a copy of the most current position description.
- Medical evidence containing diagnosis, prognosis and a treatment plan dated no more than 60 days before the date your application is filed.
- For FERS or CSRS Offset applicants: the Social Security application receipt or award notice showing you applied for Social Security disability benefits.
- A copy of the completed SF 3112A, which must accompany the SF 3112B you give your supervisor(s).
- With SF 3112B, Section B: a copy of the position description and current performance standards, and the latest performance appraisal if available.
- With SF 3112B: supporting documentation of performance, leave use or conduct problems, such as notices to the employee or medical information behind approved leave, where the supervisor reports them.
- With SF 3112C: copies of the medical reports the physician references, such as hospitalization summaries, operative reports and diagnostic test results.
- With SF 3112D: supporting medical evidence or documentation of accommodation efforts, reassignment offers or a removal notice, depending on the box the agency checks.
- SF 2801 or SF 3107, Application for Immediate Retirement, and the agency report of any Federal medical examination made; these are listed on SF 3112E for the agency to attach.
How to fill out SF 3112
Enter your identifying details
On SF 3112A, enter your name (last, first, middle) in item 1, date of birth as mm/dd/yyyy in item 2 and Social Security number in item 3. The same three items open every form in the package.
Describe your disease or injury
In items 4 through 6, fully describe each disease or injury, how it interferes with your duties, attendance or conduct, and any other restrictions on your activities. Only conditions discussed here are considered.
Report accommodations and work status
Item 7a asks what accommodations you requested, 7b whether the agency granted them (attach an explanation), and 7c your current status. If you are in leave without pay or separated, describe jobs performed since and their requirements.
Give disability and hospital dates
Item 8: the approximate date you became disabled for your position (mm/yyyy). Item 9: whether you were hospitalized; item 10: the date of your most recent hospitalization, From and To (mm/yyyy).
Complete the Social Security items
Item 11 is for FERS and CSRS Offset applicants only. Answer 11a on whether you applied for Social Security disability benefits and 11b on whether the receipt or award notice is attached.
List physicians and sign SF 3112A
In item 12, list each physician's name, address and dates of treatment, adding a sheet if needed. In item 13, sign (do not print), date (mm/dd/yyyy), and give a daytime phone number and email address.
Complete Section A of SF 3112C
Enter your name, date of birth and Social Security number. In item 4 give the exact name and address where the physician's report goes: your agency contact if employed or separated less than 30 days, or your home address if separated 31 days or more. Sign and date item 5.
Hand off the supervisor and agency forms
Give your supervisor SF 3112B with a copy of your completed SF 3112A. The supervisor completes Sections A through F, and SF 3112D (items 1 through 7) is completed by the agency official.
Check the agency checklist
SF 3112E is completed by your employing agency: service years in item 4, duty status in item 5, Social Security items in 7 and attached documents in item 8. Confirm that your information matches.
Review, sign and download the PDF
Check every item, date and signature on the forms you complete, then download or print the completed PDF from FillingPDF and keep one copy. Submit the package as described under How to submit.
How to submit SF 3112
There are two channels, 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 personnel office assembles the application package and sends it to OPM. Follow up with your agency to be sure it was sent.
- 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.
Keep one copy of each completed form for your records. Supervisors and agency officials who complete SF 3112B or SF 3112D return the original to the employee or to the personnel office and give the employee a copy; they should not send it directly to OPM unless OPM specifically asks. 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 hands it to you for delivery. The package names no fee. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Waiting to collect every document before sending SF 3112A; the package says not to delay it if you cannot get all the information.
- Leaving out the Social Security application receipt or award notice as a FERS or CSRS Offset applicant; 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.
- Submitting medical evidence dated more than 60 days before the filing date, instead of a current diagnosis, prognosis and treatment plan.
- Describing only some conditions in item 4 of SF 3112A; OPM considers only the diseases and injuries you discuss in the application.
- Printing your name on the SF 3112A signature line instead of signing; the line says "Do not print."
- Giving the supervisor SF 3112B without a copy of the completed SF 3112A, which must accompany it.
- Having the physician skip items in SF 3112C, Section B; items that do not apply must be answered "Not Applicable."
- Mailing the supervisor's or agency's form directly to OPM when OPM did not specifically request it.
- Sending the application more than one year after you separated from your position.
Frequently asked questions
What is SF3112?
SF3112 is Standard Form 3112, Documentation in Support of Disability Retirement Application, the OPM package for people applying for disability retirement from civilian Federal service. It contains SF 3112A through SF 3112E, completed by the applicant, supervisor, physician and agency.
Who fills out each form in the SF 3112 package?
The applicant completes SF 3112A and Section A of SF 3112C. The supervisor completes SF 3112B, the physician Section B of SF 3112C, the agency's Coordinator for Employment of the Handicapped SF 3112D, and the employing agency SF 3112E.
Where do I send the SF 3112 forms?
If you are still in Federal service, return everything to your agency's personnel office, which sends the package to OPM. If you were separated more than 31 days ago, mail it yourself to U.S. Office of Personnel Management, Retirement Operations Center, P.O. Box 45, Boyers, PA 16017-0045.
What is the deadline for a disability retirement application?
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, send SF 3112A anyway; the pamphlet that comes with the package explains exceptions.
Do I need Social Security paperwork with SF 3112?
Only if you apply under FERS or under CSRS with offset service. Then you must document that you applied for Social Security disability benefits by attaching the application receipt or award notice, or OPM cannot finish processing.
How recent must my 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, but states that current evidence provides the best support.
Can I fill out SF3112 online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is independent, not affiliated with OPM, and does not submit the application; it goes to OPM through your agency or by mail as described above.
Why does the Social Security award affect my OPM payments?
If Social Security awards you benefits, your OPM payments must be reduced starting on the date the Social Security award started. That can cause an overpayment, so the package advises you not to spend the Social Security money until OPM has reduced your annuity and billed you.
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