Application for Article 15 Disability Retirement (RS6340) For NYSLRS Tier 3, 4, 5 and 6 members to a 2026

1. Click ‘Get Form’ to open the Application for Article 15 Disability Retirement (RS6340) in the editor.
2. Begin by entering your NYSLRS ID and Social Security Number at the top of the form. Ensure accuracy as this information is crucial for processing your application.
3. Fill in your personal details including name, sex, date of birth, and address. Use clear typing or print in blue or black ink for legibility.
4. Indicate your payroll status by checking 'Yes' or 'No' regarding whether you are currently receiving salary. If 'No', provide an explanation.
5. Detail your medical condition(s) that have led to your disability claim. You may attach additional sheets if necessary.
6. List all doctors who have treated you, including their specialties and contact information. This section is vital for verifying your medical history.
7. Complete the hospitalization section by providing details of any relevant hospital stays related to your condition.
8. If applicable, describe any accidents that contributed to your disability and provide witness information on an additional sheet if available.
9. Finally, ensure you sign the application on the reverse side and submit it in a confidential envelope as instructed.

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