Get Si 3379 Cta

Filling out the Si 3379 Cta form can seem daunting, but with this step-by-step guide, you will be able to complete it with confidence. This document is essential for employers to provide necessary information regarding disability insurance claims on behalf of their employees.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to retrieve the Si 3379 Cta and access it for completion.
2. Begin by filling out the employee's information. This includes their full name, address, city, state, zip code, job title, class, and phone number. It is essential to print this information clearly.
3. Provide the information regarding the employee's status on the day of their disability. Specify if they were full-time, part-time, or an 11 or 12-month employee, and detail the last day worked and the number of hours worked on that day.
4. Complete the section regarding salary at the time of disability. Include details on the hourly, monthly, and annual rates as well as the average number of hours worked per day.
5. In the compensation for the period after disability section, indicate the number of sick leave days available and detail any income replacement plans or additional payments from the district.
6. Fill out the extra duty pay section, including any applicable rates and dates this pay was not received due to the employee's disability.
7. Complete the life insurance section, confirming whether the employee was covered and providing relevant policy information.
8. Provide tax information including who pays the premium for disability benefits and any other relevant details outlined in the section.
9. Compile all required attachments, such as a job description, employment application, and income documents, before submitting the form.
10. Finally, ensure that the representative from the school district reviews the completed form for accuracy, adds their signature and date, and confirms readiness for submission.

Complete the Si 3379 Cta online today to help streamline your disability insurance claims process.