North Carolina Disability Benefits

Employer Information

This page provides an overview of disability forms and training documents to help members and employers understand the process and what information is needed for each form.

Disability Process Checklist

 

To help guide you through the process, the following is a checklist of required forms listed in the order that they must be submitted.  Click on the form number to retrieve the form.  Mock-ups are available above in the "Training and Education" section to assist you with completing the form.

For members of Local Governmental Employees' Retirement System

  • Form 7 - Requesting Disability Retirement Benefits
  • Form 7A - Medical Report for Eligibility Review
  • Job Description (Provided by employer)

For members of Teachers' and State Employees' Retirement System vested on or before January 1, 1988

  • Form 7 - Requesting Disability Retirement Benefits
  • Form 7A -Medical Report for Eligibility Review
  • Job Description (Provided by employer)

For members of Teachers' and State Employees' Retirement System vested after January 1, 1988

Short-Term and/or Preliminary Long-Term application includes:

  • Form 701 - Requesting Short-Term Benefits Through the Disability Income Plan of North Carolina
  • Form 700 - Requesting Employer Information Required for Member Disability Income Plan Benefits
  • Job Description (Provided by employer)
  • Form 703 - Reporting Earnings for Short-Term Disability Benefits and Medical Report for Eligibility Review
  • Form 7A - Medical Report for Eligibility Review

Extended Short-Term or Long-Term application includes:

  • Form 704 - Requesting Additional Benefits Through DIPNC
  • Form 701 - Requesting Short-term Benefits Through the Disability Income Plan of North Carolina
  • Form 700 - Requesting Employer Information Required for Member Disability Income Plan Benefits
  • Job Description (Provided by employer)
  • Form 703- Reporting Earnings for Short-Term Disability Benefits and Medical Report for Eligibility Review
  • Form 7A - Medical Report for Eligibility Review
  • Form 711 - Determining and Recording Short-Term Disability Benefits