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Application for Article 15 Disability Retirement (RS6340) For NYSLRS Tier 3, 4, 5 and 6 members to a 2026
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- Click ‘Get Form’ to open the Application for Article 15 Disability Retirement (RS6340) in the editor.
- 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.
- 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.
- Indicate your payroll status by checking 'Yes' or 'No' regarding whether you are currently receiving salary. If 'No', provide an explanation.
- Detail your medical condition(s) that have led to your disability claim. You may attach additional sheets if necessary.
- List all doctors who have treated you, including their specialties and contact information. This section is vital for verifying your medical history.
- Complete the hospitalization section by providing details of any relevant hospital stays related to your condition.
- If applicable, describe any accidents that contributed to your disability and provide witness information on an additional sheet if available.
- Finally, ensure you sign the application on the reverse side and submit it in a confidential envelope as instructed.
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