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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.
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.
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.
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.
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.
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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.
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.
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.

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