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Application for Performance of Duty Disability Retirement (RS6047-A)

Application for Performance of Duty Disability Retirement (RS6047-A) 2025

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The document is an application form for Performance of Duty Disability Retirement for uniformed personnel in the New York State Department of Corrections and Security Hospital Treatment Assistants. It includes sections for personal information, medical conditions, treatment history, and authorization for the release of health information under HIPAA. The applicant must provide details about their disability, healthcare providers, and any related hospitalizations or occurrences. Additionally, it outlines the process for submitting the application and emphasizes the importance of accurate information.

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What is Form 3112?

Standard Form 3112 is the most vital document for federal employees seeking federal disability retirement. We cannot emphasize strongly enough how important it is to fill out an SF-3112 form correctly. Even simple mistakes can delay or upend your disability retirement application.

How much does permanent disability pay in NY?

Long-Term Disability Insurance After six months of total and continuous disability, members are eligible to receive up to 66 2/3%* of pre-disability salary with a minimum of $150 and a maximum of $5,000 per month.

How much does disability pay near New York NY?

After a seven-calendar-day waiting period or the exhaustion of your sick leave accruals (whichever is greater), you receive 50 percent of your average salary for the eight weeks before disability, up to the maximum benefit established under the New York State Disability Benefits Law, currently $170 per week.

How do I upload documents to NYS retirement?

Scan the form and save it to your computer as a PDF. Sign in to Retirement Online. Click the Upload a Member Document link on the Employer Account Homepage. Follow the steps to upload your saved version of the RS6221 form, specify the members NYSLRS ID or registration number, and click Submit.

What is the performance of duty disability in NY?

Eligibility. If you become permanently incapacitated (physically or mentally) for performance of your duties as the natural and proximate result of a disability sustained in such service, not caused by your own willful negligence, you may be eligible for this benefit regardless of the amount of service credit you have.

What is NYS disability retirement?

NYSLRS provides a disability retirement benefit for members who are permanently disabled and cannot perform their duties because of a physical or mental condition. A disability retirement benefit is a pension that will provide monthly payments for the rest of your life.

What is the NY DBL state rate?

0.50% of the first $120 of weekly wages to max of $0.60 per week. 0.511% of an employees weekly wages up to the annualized NYSAWW* ($82,917.64) for a maximum annual employee contribution of $423.71.

What is the disability benefits law in NY?

The Disability Benefits Law (Article 9 of the WCL) provides weekly cash benefits to replace, in part, wages lost due to injuries or illnesses that do not arise out of or in the course of employment (WCL 204). Medical care is the responsibility of the employee and is not paid for by the employer or insurance carrier.

Application for Performance of Duty Disability Retirement (RS6047-A) 2025

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