Form rs 6047 a-2025

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26 votes

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 instructions for submission, personal information requirements, medical condition disclosures, and authorization for the release of health information under HIPAA. The form seeks to gather details about the applicant's disability, treatment history, and intended beneficiaries.

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Versions	Form popularity	Fillable & printable
2022	4.2 Satisfied (40 Votes)
2018	4.7 Satisfied (88 Votes)
2013	4.1 Satisfied (26 Votes)

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