Get Sickness Notification

This guide provides comprehensive and supportive instructions on how to effectively complete the Sickness Notification online. Users will find clear steps to ensure accurate submission of their sickness benefit application.

Follow the steps to successfully complete your Sickness Notification

1. To obtain the Sickness Notification form, press the ‘Get Form’ button to access it in your online editor.
2. Begin by filling out the claim number and date filed at the top of the form. Make sure these fields are clearly marked to avoid confusion later.
3. Provide your Social Security System number and your personal information in the claimant section. This includes your first name, middle initial, and last name, as well as your date of birth.
4. Complete your full address to ensure accurate communication from the Social Security System.
5. Indicate the date you notified the Social Security System and the details of your confinement. Fill out the period of confinement, including the start and end dates and the place of confinement (hospital or home).
6. Answer whether you were employed during the sickness period by checking ‘Yes’ or ‘No.’ If ‘Yes,’ provide your employer's details, including name, address, period of employment, employer ID number, separation date, and total monthly salary credits.
7. If you have been separated from your employer, complete the certification section, which requires the printed name, signature of the company representative, and their official designation.
8. Certify the accuracy of the information provided by signing the form and including your Tax Account Number if applicable.
9. If you have previous employers, list them in the specified section with their details for the inclusive periods of employment.
10. After completing the form, review all entries for accuracy. Once finalized, save your changes, then download or print the form for submission.

Begin filling out your Sickness Notification online today for a seamless process.