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Notes
(For forced or constructively discharged* Disability Retirement applications)
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SF-3107 (PDF)
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Application for Immediate
Retirement
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Applicant
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General application required for both disability and non-disability
retirement application.
It might be a good idea to submit SF 3112A (below) before submitting SF
3107 to ensure processing disability retirement. Otherwise, Agency may
in some cases delay or ignore processing 3112A to activate
non-disability retirement, especially when your disability retirement was
forced upon you due to deterioration of health, which was in turn, as you
might have alleged, caused by Agency's denial of your reasonable
accommodation requests, discrimination, retaliation, or harassment.
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SF 3107-1
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Certified Summary of
Federal Service
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To be filled out by Agency,
then employee verifies the
info by filling out Section E
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SF 3107-
Schedule A, B, C
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Schedule A: Military
Service Information
Schedule B: Military
Retired Pay
Schedule C: Federal
Employees
Compensation Information
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Applicant
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Schedule C asks about your Workers’ Compensation benefit application,
payment, or pending claim.
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SF 3107-
Schedule D
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Agency Checklist of
Immediate Retirement
Procedures
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Agency
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In box 4, there is choice for "Involuntary Retirement” and for “Disability.” If
retiring on forced disability retirement, both choices should be checked.
Section B states the following obligation on the part of the Agency: "SF
3100 or SF 3100A for applicant must be closed out and sent to OPM no
later than 5 days after the pay date of the final paycheck."SF
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SF 3112 (PDF)
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Documentation in Support
of Disability Retirement
Application
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Important instructions regarding disability applications with reference to
pamphlet and necessary forms required. If still employed, Agency will
send the originals to Office of Personnel Management (OPM). If not, you
must send to OPM at address provided in this instruction. It has info
regarding obligation to apply for Social Security disability benefits prior to
applying for disability retirement. It also states: “OPM must receive your
application not more than one year after the date you separated from your
position. If you are unable to get all the information requested, do not
delay submitting your Standard Form 3112A to OPM (via your Agency if
still employed).
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SF 3112A
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Applicant’s Statement of
Disability
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Applicant
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In box 7a, list all reasonable accommodation (RA) requests you made
based on your disability such as date, to whom, types of RA you
requested. You may refer to EEO case no as applicable. Use attached
sheet to write in detail. If you do, write in box 7a: “See attached my
signed statement dated [date???] entitled: Attachment to Applicant’s
Statement of Disability (SF 3112A).” Make sure to state in the attachment
the following, if applicable and appropriate: “Due to harassment,
intimidation, discrimination, retaliation, and denial of reasonable
accommodations by Agency, my disability worsened to the point where I
had no choice but to apply for disability retirement. Attached are my
formal EEO claims regarding the aforementioned allegations. Had I not
been discriminated or retaliated against; and had my requests for
reasonable accommodations been granted; my disability would not have
worsened to the point of inability to work; and I would not have had to
apply for disability retirement.”
Box 11 states: “Application for disability retirement under FERS or CSRS
Offset requires an application for Social Security Disability Benefits. Final
processing at OPM cannot be completed without a copy of your Social
Security application receipt or award notice.
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SF 3112B
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Supervisor’s Statement
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Immediate Supervisor
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Supervisor fills out regarding your performance, attendance, conduct,
and info regarding accommodation and reassignment.
Under Americans with Disability Act (ADA) and the equivalent
Rehabilitation Act (ADA for federal employees), Agency must engage in
interactive process to work out a reasonable and suitable
accommodation(s) with employee. Unless undue hardship on the part
of Agency, reasonable accommodation(s) must be granted. The
Court/EEOC ultimately decides what “undue hardship” is. You and
Agency together decide what reasonable and suitable accommodations
are. If reasonable accommodation is denied, file an EEO claim within 45
days of knowledge of denial (if federally employed).
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SF 3112C
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Physician’s Statement
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Sect. A by Applicant
Sect. B by physician
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Applicant must attach a copy of the most current position description
(PD). If not provided, write your own as best as you can, sign, and date,
and attach it, stating: “I have not been provided with the most recent
position description. Therefore, below is the position description to the
best of my knowledge and information for the position I performed since
[date????].” Up-to-date PD is necessary for your physician to determine,
as best as he or she can, whether you can perform the job with or without
accommodation.
You are signing, as you must, the authorization for your physician to
release medical information to OPM and to the Agency relevant to your
disability retirement application.
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SF 3112D
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Agency Certification of
Reassignment and
Accommodation Efforts
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Coordinator for Employment
or the Handicapped or other
authorized agency official
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Instruction says in part: “The Coordinator for Employment of the
Handicapped should review the Applicant’s Statement, the Supervisor’s
Statement, the Physician’s Statement, and any other relevant
documentation on file to determine if reasonable accommodation will
enable the employee to perform fully successful service in his or her
current position or whether a vacant position is available in the agency, at
the same grade or pay level in the same commuting area, for which the
employee is qualified for reassignment.”
Under Americans with Disability Act (ADA) and the equivalent
Rehabilitation Act (ADA for federal employees), Agency must engage in
interactive process to work out a reasonable and suitable
accommodation(s) with employee. Unless undue hardship on the part
of Agency, reasonable accommodation(s) must be granted. The
Court/EEOC ultimately decides what “undue hardship” is. You and
Agency together decide what reasonable and suitable accommodations
are. If reasonable accommodation is denied, file an EEO claim within 45
days of knowledge of denial (if federally employed).
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SF 3112E
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Disability Retirement
Application Checklist
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Agency
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Box 9 asks: “Has the supervisor stated the employee’s performance is
less than fully successful in any critical element of the position in Section
B, SF 3112B?”
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* Constructive Discharge is a legal concept often argued when an employee is forced to resign, retire, take demotion, or be transferred to less desirable position as
result of intolerable working conditions caused by on-going discrimination, retaliation, harassment, and/or denied accommodation (if requested). A constructive
discharge claim involving disability retirement (i.e., forced disability retirement) must show that you had no choice but to retire on disability because your health
deteriorated to the point where you could no longer work; and that your health was deteriorated due to Agency's discrimination, retaliation, harassment, and/or denied
accommodation (if requested). If a constructive discharge claim is proven and established, you can be compensated as if you were unlawfully terminated in terms of
lost wages or salary differential. In general, the standard of proof for a constructive discharge is higher than termination. The standard is objective: Due to intolerable
working conditions, anyone (not just you) in the same or similar circumstances would have had no choice but to separate, as you did. You may claim and file a
constructive discharge discrimination/retaliation complaint after OPM approves your disability retirement application, if your disability was indeed made worse by
discrimination, retaliation, harassment, and/or denied accommodation (if requested) to the point where you could no longer work. See Constructive Discharge for more
information.
Disability discrimination, reasonable accommodation, constructive discharge, disability retirement and Worker's Comp
Disclaimer: All information contained in this website is subject to change and update. EEO 21, LLC is not responsible for any errors or misrepresentation contained therein.
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