Disability Benefit Application Packet Information
This page lists the necessary forms and information regarding applying for a disability benefit. Submission of all packet documentation is essential in processing your disability benefit application.
More information regarding the disability program can be found in the Disability Benefits leaflet (PDF opens in new tab).
| Disability Benefit Application Packet |
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Disability Benefit Application (DR-1)This is the application to apply for a disability benefit
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Disability Benefit Application (DR-HIPAA)This form is to authorize your health care providers to disclose your medical records to the Ohio Public Employees Retirement System (OPERS) and OPERS’ third-party administrator for the purpose of determining your initial or ongoing eligibility for disability benefits. |
Report of Physician (DR-APS)This form is to be completed by the applicant's physician. The physician completing this form must be a MD or DO.
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Proof of Date of Birth (F-6)The form below provides documents that will be acceptable for proof of a member's date of birth.
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Designation of Beneficiary for Lump Sum Death Benefit for Traditional Pension Plan (DBO-3T)This form is used to designate a beneficiary. Designation of Beneficiary for Lump Sum Death Benefit for Traditional Pension Plan
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Report of Employer for Disability Benefit Applicant (DR-4)Upon receipt of a member's disability benefit application, a Report of Employer for Disability Benefit Applicant will be sent by OPERS, to the member's last public employer for completion. |
Obtaining a Disability Application Packet
If you would like to be mailed the Disability Benefit Application Packet, you can order it on the Forms & Documents page. Search for 'Disability Benefit Application Packet', select 'order' and fill out the form at the bottom of the page.