Get Form Dsbl1: Pre-application For Disability Retirement Benefits

Filling out the Form DSBL1: Pre-Application For Disability Retirement Benefits is a crucial step in securing disability retirement benefits. This guide provides detailed instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the Form DSBL1 online.

1. Press the ‘Get Form’ button to access the Form DSBL1 and open it for online completion.
2. In the member information section, enter your first name, middle initial, last name, gender, social security number, birth date, email address, mailing address, and phone number. Select the type of disability (non-duty related or duty related) and attach a copy of your birth certificate.
3. If applicable, indicate whether you served active duty in the U.S. Armed Forces. If you answer 'yes,' attach Form DD214.
4. Select the retirement plan that applies to you from the options provided: Public Employees’ Retirement System of Mississippi, Mississippi Highway Safety Patrol Retirement System, or Supplemental Legislative Retirement Plan.
5. List potential beneficiaries for estimation purposes only, providing their names, social security numbers, birth dates, and relationships.
6. Review and complete the applicant authorization section. Ensure you understand that the pre-application will become null if required documents are not submitted within 90 days. Sign and date the form.
7. If completing the employer certification section, ensure an authorized representative fills it out. They should certify the member's position, official hire and termination dates, and acknowledge any traumatic events that occurred in the performance of duty.
8. Provide projected unreported earnings and leave payments, if applicable. Include details about the employee's leave accrual rates and any increases in salary or compensation.
9. Finally, review all sections to ensure all information is accurate and complete. Save your changes, and then download, print, or share the completed form as needed.

Begin the online process today to secure your disability retirement benefits.