OPM · Official form

SF 3112: Documentation in Support of Disability Retirement

SF 3112 is the set of forms that documents a federal employee's application for disability retirement, combining statements from the applicant, the supervisor, the treating physician, and the agency.

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What is SF 3112?

SF 3112 is not a single form but a package: SF 3112A is the applicant's statement of disability, SF 3112B is the supervisor's statement about performance and conduct, SF 3112C is the physician's statement with instructions for medical documentation, SF 3112D is the agency's certification of its efforts to reassign or accommodate the employee, and SF 3112E is a checklist the agency uses to confirm the package is complete.

The package accompanies the retirement application itself, SF 3107 for FERS employees or SF 2801 for CSRS employees. OPM decides disability claims on the written record, so the quality and consistency of these documents matters. The applicant completes SF 3112A; the other parts are completed by the supervisor, physician, and agency.

Who files SF 3112?

Federal employees applying for disability retirement because a medical condition prevents useful and efficient service in their position
Supervisors documenting the employee's performance, conduct, and attendance on SF 3112B
Treating physicians providing the medical narrative requested by SF 3112C
Agency HR offices certifying accommodation and reassignment efforts on SF 3112D and assembling the package

How to fill out SF 3112

Complete SF 3112A yourself, describing your medical conditions and how they prevent you from performing the critical elements of your job.
Ask your supervisor to complete SF 3112B and your treating physician to respond to SF 3112C with supporting medical records.
Your agency completes SF 3112D, certifying whether accommodation or reassignment was possible, and reviews the package against the SF 3112E checklist.
File the SF 3112 package together with your retirement application (SF 3107 for FERS) through your agency HR office.
If you have been separated from federal service for more than 31 days, send your application directly to OPM instead; it must be received within one year of your separation.

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These are the form's own fields, in the order they appear on the pages. Fill in what you know; anything left blank stays a fillable field in the PDF, so you can finish it in any PDF reader. Nothing you type here is sent to OPM.

Page 2 23 fields

Page 3 28 fields

Applicant's Statement of Disability. Number 12. Line 1. Enter your physician or physicians name or names.

Applicant's Statement of Disability. Number 12. Line 2. Enter your physician or physicians name or names.

Applicant's Statement of Disability. Number 12. Line 3. Enter your physician or physicians name or names.

Applicant's Statement of Disability. Number 12. Line 4. Enter your physician or physicians name or names.

Applicant's Statement of Disability. Number 12. Line 5. Enter your physician or physicians name or names.

Applicant's Statement of Disability. Number 12. Line 6. Enter your physician or physicians name or names.

Applicant's Statement of Disability. Number 12. Line 7. Enter your physician or physicians name or names.

Applicant's Statement of Disability. Number 12. Line 8. Enter your physician or physicians name or names.

Applicant's Statement of Disability. Number 12. Line 1. Enter your physician or physicians address or addresses.

Applicant's Statement of Disability. Number 12. Line 2. Enter your physician or physicians address or addresses.

Applicant's Statement of Disability. Number 12. Line 3. Enter your physician or physicians address or addresses.

Applicant's Statement of Disability. Number 12. Line 4. Enter your physician or physicians address or addresses.

Applicant's Statement of Disability. Number 12. Line 5. Enter your physician or physicians address or addresses.

Applicant's Statement of Disability. Number 12. Line 6. Enter your physician or physicians address or addresses.

Applicant's Statement of Disability. Number 12. Line 7. Enter your physician or physicians address or addresses.

Applicant's Statement of Disability. Number 12. Line 8. Enter your physician or physicians address or addresses.

Applicant's Statement of Disability. Number 12. Line 1. Enter the date of treatments. Enter a two digit month and day and a four digit year.

Applicant's Statement of Disability. Number 12. Line 2. Enter the date of treatments. Enter a two digit month and day and a four digit year.

Applicant's Statement of Disability. Number 12. Line 3. Enter the date of treatments. Enter a two digit month and day and a four digit year.

Applicant's Statement of Disability. Number 12. Line 4. Enter the date of treatments. Enter a two digit month and day and a four digit year.

Applicant's Statement of Disability. Number 12. Line 5. Enter the date of treatments. Enter a two digit month and day and a four digit year.

Applicant's Statement of Disability. Number 12. Line 6. Enter the date of treatments. Enter a two digit month and day and a four digit year.

Applicant's Statement of Disability. Number 12. Line 7. Enter the date of treatments. Enter a two digit month and day and a four digit year.

Applicant's Statement of Disability. Number 12. Line 8. Enter the date of treatments. Enter a two digit month and day and a four digit year.

Applicant's Statement of Disability. Number 13. Enter the date you signed the form certifying that all statements made are true to the best

Applicant's Statement of Disability. Number 13. Enter your email address.

Applicant's Statement of Disability. Number 13. Enter your area code.

Applicant's Statement of Disability. Number 13. Enter your day time telephone number.

Page 4 15 fields

Supervisor's Statement. Section, A, Applicant Identification. Number 3. Enter the applicant's social security number.

Supervisor's Statement. Section B, Information About Employee's Performance. Number 3. This is the no, checkbox. Press the space bar to

Supervisor's Statement. Section, A, Applicant Identification. Enter the applicant's date of birth. Enter a two digit month and day and a

Supervisor's Statement. Section B, Information About Employee's Performance. Number 5. This is the yes, checkbox. Press the space bar to

Supervisor's Statement. Section B, Information About Employee's Performance. Number 5. This is the No, checkbox. Press the space bar to

Supervisor's Statement. Section B, Information About Employee's Performance. Number 4. Enter the approximate date that unacceptable

Supervisor's Statement. Section B, Information About Employee's Performance. Number 5. Enter the beginning date of period the increase or

Supervisor's Statement. Section B, Information About Employee's Performance. Number 5. Enter the ending date of period the increase or

Supervisor's Statement. Section B, Information About Employee's Performance. Number 5, a,. This is the yes, check box. Press the space bar

Supervisor's Statement. Section B, Information About Employee's Performance. Number 5, a,. This is the no, checkbox. Press the space bar to

Supervisor's Statement. Section B. Information About Employee's Performance. Number 1. Enter the title of position of record. Attach a copy

This is the Supervisor's Statement. You must print two copies of this page and the next page. This is the original - To O P M through

Supervisor's Statement. Section, A, Applicant Identification. Number 1. Enter the applicant's name in last, first, middle format.

Supervisor's Statement. Section B, Information About Employee's Performance. Number 3. This is the yes, checkbox. Press the space bar to

Supervisor's Statement. Section B. Information About Employee's Performance. Number 2. Enter the date of entry into position. Enter a two

Page 5 29 fields

Page 6 5 fields

Physician's Statement. Section, A, Identifying Information and Consent. To be completed by applicant. Number 3. Enter your social security

Physician's Statement. Section, A, Identifying Information and Consent. To be completed by applicant. Number 1. Enter your name in last,

Physician's Statement. Section, A, Identifying Information and Consent. To be completed by applicant. Number 4. If you are currently

Physician's Statement. Section, A, Identifying Information and Consent. To be completed by applicant. Number 5. Enter the date you signed

Physician's Statement. Section, A, Identifying Information and Consent. To be completed by applicant. Number 2. Enter your date of birth.

Page 8 8 fields

Agency Certification of Reassignment and Accommodation Efforts. To be completed by Coordinator for Employment of the Handicapped or other

Agency Certification of Reassignment and Accommodation Efforts. You must print two copies of this form. Print copy one which is for OPM

Page 9 19 fields

Agency Certification of Reassignment and Accommodation Efforts. To be completed by Coordinator for Employment of the Handicapped or other

Agency Certification of Reassignment and Accommodation Efforts. Certification by Coordinator for Employment of the Handicapped or other

Page 10 71 fields

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Frequently asked questions

Do I have to apply for Social Security disability too?

FERS applicants must apply for Social Security disability benefits and provide proof of the application before OPM can approve FERS disability retirement. Denial of the Social Security claim does not automatically disqualify the OPM claim.

What is the deadline for a disability retirement application?

The application must generally be received by your agency or OPM within one year after your separation from federal service. Waivers are rare and limited to cases such as mental incompetence, so do not rely on getting one.

Who decides my claim?

OPM adjudicates the claim based on the written record in the SF 3112 package and the medical evidence. Your agency does not approve or deny disability retirement; it documents and certifies its parts of the file.

SF 3112: Documentation in Support of Disability Retirement

What is SF 3112?

Who files SF 3112?

How to fill out SF 3112

Quick fill SF 3112 on this page

Frequently asked questions

Related forms

SF 3107: Application for Immediate Retirement (Federal Employees Retirement System)

SF 2818: Continuation of Life Insurance Coverage as an Annuitant or Compensationer

SSA-3373-BK: Function Report - Adult