Disability Application Forms

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To apply for disability retirement benefits, your employee may need a form for:

Requesting Disability Retirement Benefits	Form 7
Medical Report for Disability Eligibility Review	Form 7A
Requesting Disability Status from the Firemen's and Rescue Squad Workers' Pension Fund	Form 7FR

If the employee is approved for disability retirement, he or she will be mailed the following form. We are providing you a sample so that you have the opportunity to counsel the member.

Choosing a Disability Retirement Payment Option Form

Sample
Form 7E

To apply for disability benefits from the Disability Income Plan of North Carolina, your employee may need a form for:

Requesting the Short-Term of Benefits Through the Disability Income Plan of North Carolina	Form 701
Reporting Earnings to Your Employer During the Short Term	Form 702
Medical Report for Eligibility Review of Short-Term Disability Benefits	Form 703
Requesting Additional Benefits Through the Disability Income Plan of North Carolina	Form 704
Medical Report for Disability Eligibility Review	Form 7A

To administer short term benefits through the Disability Income Plan of North Carolina, you may need the following forms for:

Determining the Waiting Period Before the Short Term Begins	Form 710
Determining the Maximum Monthly Benefit During the Short Term	Form 711
(Optional) Determining the Affect of Other Benefits on the Short-Term Benefit	Form 712
(Optional) Determining the Short-Term Benefit for Partial and Special Months (employer use only)	Form 713
Employer's Payment Record, Reimbursement Calculation, and Service Credit Report (employer use only)	Form 714