Get City Statement Of Occupational Disability

Filling out the City Statement of Occupational Disability is a crucial step for members seeking occupational disability retirement benefits. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the online form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the member's information in the designated fields. This includes the member's name (first, middle, last), social security number, mailing address, and daytime phone number. Ensure that all information is typed or written in black ink without any highlighting.
3. Provide the employing city information to accurately reflect the member's workplace. This information is essential for the processing of the disability claim.
4. In the job description section, provide a brief statement of the member's job description and duties. You must also attach a photocopy of the employee's official job description.
5. Complete the section regarding the activities customarily required for the position. Indicate the frequency (never, occasionally, or frequently) and duration (for how long at a time) of various physical demands such as lifting, carrying, bending, walking, and other relevant tasks.
6. In the City Official Certification section, a designated city official must certify that the information is complete and accurate. They should sign and include their printed name, title, and the date signed.
7. Review all provided information for accuracy. Make necessary corrections where needed and ensure that any changes are initialed.
8. Once the form is complete, save your changes, and prepare to download or print the document. You can also share it with relevant parties as required.

Take the next step and complete your City Statement of Occupational Disability form online today.