HOME - Benefits - Kansas Department of LaborHome - Kansas Department Of LaborHome - Kansas Department Of LaborKansas Department of Labor 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Social Security Number (SSN) and Claimant Name in the designated fields.
3. Select the type of pension or retirement benefit you are receiving by checking the appropriate box.
4. For Federal Civilian, State, County, or City Government Service, or Private Employment, fill in your employer's name and gross monthly amount of pension/retirement. Also, indicate who contributed to the account and their percentage.
5. If applicable, provide details for Military Service including service branch and discharge date. Enter the gross monthly amount and whether you receive any disability benefits.
6. For Union pensions, specify your union local and complete similar fields as above regarding contributions.
7. If you have received IRA distributions, check the relevant options and provide amounts and dates as required.
8. Attach necessary documentation from your former employer or pension administrator to support your responses.
9. Finally, certify that all information is correct by signing and dating the form before submission.

Start using our platform today to streamline your form completion process for free!