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Get Form Lc 4571 19
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How to fill out the Form Lc 4571 19 online
Filling out Form Lc 4571 19 online can be streamlined with clear guidance. This form is essential for applying for long-term disability income benefits. Follow this guide to ensure that your application is completed correctly and efficiently.
Follow the steps to complete the form accurately.
- Press the ‘Get Form’ button to access the form and open it for editing.
- Fill out Section I with the employer's details, including the employee's name, social security number, date of birth, and the employer's information.
- In Section II, the employee must provide personal information including their address, social security number, and occupation.
- Section III requires the employee's authorization to obtain information, which must be signed by the employee.
- The attending physician must complete Section IV, providing necessary medical information related to the employee's condition.
- Ensure all sections are fully completed and signed. Attach any necessary documents as specified in Section K.
- After filling out the form, save your changes, and you can choose to download, print, or share the completed document.
Complete your documents online today for a smoother process.
To be eligible for Short Term Disability, the employee must have at least one year of contributing membership in either TSERS or the ORP, earned within 36 months prior to the onset of the disability.
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