A Guide to (forced) Disability Retirement Application Forms

• Note: For forced or constructively discharged* Disability Retirement applications

➤ Form: SF-3107 

•  Application for Immediate Retirement

➤ Filled out by: Applicant

➤ Notes: 

• General application required for both disability and non-disability retirement application.  
• It might be a good idea to submit SF 3112A (below) before submitting SF 3107 to ensure processing disability retirement.  Otherwise, Agency may in some cases delay or ignore processing 3112A to activate non-disability retirement, especially when your disability retirement was forced upon you due to deterioration of health, which was in turn, as you might have alleged, caused by Agency's denial of your reasonable accommodation requests, discrimination, retaliation, or harassment.

➤ Form: SF 3107-1

• Certified Summary of Federal Service

➤ Filled out by: To be filled out by Agency, then employee verifies the info by filling out Section E

➤ Notes: n/a

➤ Form: SF 3107 - Schedule A, B, C

• Schedule A: Military Service Information
• Schedule B: Military Retired Pay
• Schedule C: Federal Employees Compensation Information

➤ Filled out by: Applicant

➤ Notes:

• Schedule C asks about your Workers’ Compensation benefit application, payment, or pending claim.  

➤ Form: SF 3107 - Schedule D

•  Agency Checklist of Immediate Retirement Procedures

➤ Filled out by: Agency

➤ Notes:

• In box 4, there is choice for "Involuntary Retirement” and for “Disability.”  If retiring on forced disability retirement, both choices should be checked.  Section B states the following obligation on the part of the Agency: "SF 3100 or SF 3100A for applicant must be closed out and sent to OPM no later than 5 days after the pay date of the final paycheck."

➤ Form: SF 3112

• Documentation in Support of Disability Retirement Application

➤ Filled out by: n/a

➤ Notes:

• Important instructions regarding disability applications with reference to pamphlet and necessary forms required. If still employed, Agency will send the originals to Office of Personnel Management (OPM).  If not, you
  must send to OPM at address provided in this instruction.  It has info regarding obligation to apply for Social Security disability benefits prior to applying for disability retirement.   It also states: “OPM must receive your application not more than one year after the date you separated from your position.  If you are unable to get all the information requested, do not delay submitting your Standard Form 3112A to OPM (via your Agency if still employed).

➤ Form: SF 3112A

• Applicant’s Statement of Disability

➤ Filled out by: Applicant

➤ Notes:

•  In box 7a, list all reasonable accommodation (RA) requests you made based on your disability such as date, to whom, types of RA you requested.  You may refer to EEO case no as applicable.  Use attached sheet to write in detail.  If you do, write in box 7a: “See attached my signed statement dated [date???] entitled: Attachment to Applicant’s Statement of Disability (SF 3112A).”  Make sure to state in the attachment the following, if applicable and appropriate: “Due to harassment, intimidation, discrimination, retaliation, and denial of reasonable accommodations by Agency, my disability worsened to the point where I had no choice but to apply for disability retirement.  Attached are my formal EEO claims regarding the aforementioned allegations.  Had I not been discriminated or retaliated against; and had my requests for reasonable accommodations been granted; my disability would not have worsened to the point of inability to work; and I would not have had to apply for disability retirement.”
• Box 11 states: “Application for disability retirement under FERS or CSRS Offset requires an application for Social Security Disability Benefits.  Final processing at OPM cannot be completed without a copy of your Social Security application receipt or award notice.

➤ Form: SF 3112B

• Supervisor’s Statement

➤ Filled out by: Immediate Supervisor

➤ Notes:

• Supervisor fills out regarding your performance, attendance, conduct, and info regarding accommodation and reassignment.
• Under Americans with Disability Act (ADA) and the equivalent Rehabilitation Act (ADA for federal employees), Agency must engage in interactive process to work out a reasonable and suitable accommodation(s) with employee.  Unless undue hardship on the part of Agency, reasonable accommodation(s) must be granted. The Court/EEOC ultimately decides what “undue hardship” is.  You and Agency together decide what reasonable and suitable accommodations are.  If reasonable accommodation is denied, file an EEO claim within 45 days of knowledge of denial (if federally employed).  

➤ Form: SF 3112C

• Physician’s Statement

➤ Filled out by: Sect. A by Applicant/ Sect. B by physician

➤ Notes:

• Applicant must attach a copy of the most current position description (PD).  If not provided, write your own as best as you can, sign, and date, and attach it, stating: “I have not been provided with the most recent position description.  Therefore, below is the position description to the best of my knowledge and information for the position I performed since [date????].”   Up-to-date PD is necessary for your physician to determine, as best as he or she can, whether you can perform the job with or without accommodation.

• You are signing, as you must, the authorization for your physician to release medical information to OPM and to the Agency relevant to your disability retirement application.

➤ Form: SF 3112D

• Agency Certification of Reassignment and Accommodation Efforts

➤ Filled out by: Coordinator for Employment or the Handicapped or other authorized agency official

➤ Notes:

• Instruction says in part: “The Coordinator for Employment of the Handicapped should review the Applicant’s Statement, the Supervisor’s Statement, the Physician’s Statement, and any other relevant documentation on file to determine if reasonable accommodation will enable the employee to perform fully successful service in his or her current position or whether a vacant position is available in the agency, at the same grade or pay level in the same commuting area, for which the employee is qualified for reassignment.”  
• Under Americans with Disability Act (ADA) and the equivalent Rehabilitation Act (ADA for federal employees), Agency must engage in interactive process to work out a reasonable and suitable accommodation(s) with employee.  Unless undue hardship on the part of Agency, reasonable accommodation(s) must be granted. The Court/EEOC ultimately decides what “undue hardship” is.  You and Agency together decide what reasonable and suitable accommodations are.  If reasonable accommodation is denied, file an EEO claim within 45 days of knowledge of denial (if federally employed).

➤ Form: SF 3112E

• Disability Retirement Application Checklist

➤ Filled out by: Agency

➤ Notes:

• Box 9 asks: “Has the supervisor stated the employee’s performance is less than fully successful in any critical element of the position in Section B, SF 3112B?”

* Constructive Discharge is a legal concept often argued when an employee is forced to resign,retire, take demotion, or be transferred to less desirable position as result of intolerable working conditions caused by on-going discrimination, retaliation, harassment, and/or denied accommodation (if requested).  A constructive discharge claim involving disability retirement (i.e., forced disability retirement) must show that you had no choice but to retire on disability because your health deteriorated to the point where you could no longer work; and that your health was deteriorated due to Agency's discrimination, retaliation, harassment, and/or denied accommodation (if requested).  If a constructive discharge claim is proven and established,you can be compensated as if you were unlawfully terminated in terms of lost wages or salary differential.  In general, the standard of proof for a constructive discharge is higher than termination.  The standard is objective: Due to intolerable working conditions, anyone (not just you) in the same or similar circumstances would have had no choice but to separate, as you did. You may claim and file a constructive discharge discrimination/retaliation complaint after OPM approves your disability retirement application, if your disability was indeed made worse by discrimination, retaliation, harassment, and/or denied accommodation (if requested) to the point where you could no longer work.  See Constructive Discharge for more information.  

Disclaimer: All information contained in this website is subject to change and update. EEO 21, LLC is not responsible for any errors or misrepresentation contained therein.