Disability Benefit Application Packet Information
More information regarding the disability program can be found on the Disability Benefits home page or in the Disability Benefits leaflet.
DR-1 Disability Benefit Application - The Members application to apply for a disability benefit
DR-APS - Report of Physician - This form is to be completed by the member's physician. The physician completing this form must be a MD or DO
Proof of Date of Birth - The form below provides documents that will be acceptable for proof of a member's date of birth.
W-4P - Federal withholding Certificate for Pension or Annuity Payments
IT-4P - Recipients Withholding Certificate for Ohio Personal Income Tax
DBO-3T - Designation of Beneficiary for Lump Sum Death Benefit for Traditional Pension Plan
DR - 4 Report of Employer for Disability Benefit Applicant - 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.
If you would like to be mailed the Disability Benefit Application Packet, please check the box next to the Disability Benefit Application Packet on the member's forms page and fill out the form at the bottom of the page.