Federal employees applying for CSRS or FERS disability retirement give SF 3112C to each treating physician, along with their position description. Section B asks the physician for objective medical documentation on letterhead: detailed history, test reports, diagnosis, prognosis and restrictions, showing specifically why the patient cannot perform their duties. OPM evaluates it with the rest of the SF 3112 package.
The applicant completes Section A, identifying information and consent to release records, and attaches the current position description. The treating physician completes Section B by answering each numbered documentation requirement on letterhead and marking items that do not apply as not applicable.
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Physician's Statement In Connection With Disability Retirement Under the Civil Service Retirement System and the Federal Employees Retirement System
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The applicant. The Section B instructions state that the applicant is responsible for any costs incurred in providing the documentation. OPM does not pay the treating physician for the statement, so any charge for the report and copies of records is settled between the physician's office and the patient.
OPM asks for the statement within 2 weeks. The packet instructions also tell applicants that the diagnosis, prognosis and treatment plan should be dated no more than 60 days before the application is filed, because current evidence best supports the claim. Incomplete information delays processing.
In a sealed envelope marked 'Medical Disability - Privileged - Private' to the name and address in Section A item 4: the agency office if the employee is still employed or recently separated, or the applicant's home if separated 31 days or more. The physician may also give the sealed envelope to the applicant.