Get Application For Performance Of Duty Disability Retirement (rs6047-a). For Nyslrs Correction

This guide provides comprehensive instructions on completing the Application For Performance Of Duty Disability Retirement (RS6047-A) for NYSLRS Correction. Whether you are familiar with digital forms or not, this step-by-step approach will ensure that you fill out the application accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in your document editor.
2. Begin with entering your NYSLRS ID and your Social Security Number in the designated fields. Ensure you only input the last four digits of your Social Security Number.
3. Indicate your Retirement System by selecting either Employees’ Retirement System (ERS) or Police and Fire Retirement System (PFRS).
4. Check off the benefit(s) you are applying for, which include options like heart-related issues or tuberculosis. If applicable, list occurrences in Section 14.
5. Fill in your full name (First, Middle Initial, Last), date of birth, address inclusive of street, city, state, and zip code.
6. Provide your contact information, including work, home, and cell phone numbers.
7. Specify your payroll title and employer name to help identify your position.
8. Indicate the length of your service in years and months.
9. Confirm your payroll status by selecting 'Yes' or 'No' for being on payroll and receiving a salary. If 'No,' provide an explanation.
10. Detail the medical condition(s) that render you permanently disabled. Additional sheets may be used if necessary.
11. List the names and specializations of the doctors you have been treated by, ensuring to provide their contact information.
12. Document any hospitalizations you've experienced, including dates of admission.
13. Provide dates of occurrences related to your claim, where they occurred, and any assigned Workers’ Compensation numbers.
14. In Section 14, describe the occurrences and relate them to your claimed disability. Provide names and contact information of witnesses if available.
15. Complete the beneficiary information section, including their name, relationship to you, and address.
16. Certify the application by signing on the designated line, ensuring to print your name and date the application.
17. Once completed, save your changes. You may choose to download, print, or share the form as needed.

Complete your documents online to ensure a smooth submission process.