Get OPM SF 3112A 2011
Retirement System In Connection With Disability Retirement Under the Civil Service Retirement System or the Federal Employees Retirement System A copy of this completed form must accompany the Supervisor's Statement you give your supervisor(s). 2. Date of birth (mm/dd/yyyy) Federal Employees Retirement System Form Approved: OMB No. 3206-0228 3. Social security number 1. Name (last, first, middle) 4. Fully describe your disease(s) or injury(ies.) We consider only the diseases and/or in.
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