Cover page: instructions
Explains the package, where completed forms go, the Social Security requirement for FERS and CSRS offset applicants, and the one-year time limit after separation.
SF3112
Documentation in Support of Disability Retirement Application
- Agency
- GSA
- Revision
- Revised May 2011
- Fillable fields
- 213
- Pages
- 10
- Official source
- GSA form page
- Checked
- October 20, 2026
Standard Form 3112 (SF 3112): Documentation in Support of Disability Retirement
Standard Form 3112 (SF 3112), Documentation in Support of Disability Retirement Application, is a package of forms for applicants for disability retirement from civilian Federal service under the Civil Service Retirement System (CSRS) or the Federal Employees Retirement System (FERS). It is a U.S. Office of Personnel Management (OPM) form, Revised May 2011, OMB No. 3206-0228. GSA hosts a copy in its forms library.
The package holds SF 3112A, Applicant's Statement of Disability; SF 3112B, Supervisor's Statement; SF 3112C, Physician's Statement; SF 3112D, Agency Certification of Reassignment and Accommodation Efforts; and SF 3112E, Disability Retirement Application Checklist. The applicant, the supervisor, a physician and agency officials each complete their own form, and the originals go to OPM.
The cover page says applicants should have received a pamphlet, Information About Disability Retirement, with the package. You can fill it out free in your browser on this page and download the result without an account.
What's in the SF 3112 package
SF 3112A: Applicant's Statement of Disability
Items 1 to 13: the disease or injury, how it affects duties, attendance or conduct, accommodations requested, current status, dates, hospitalization, Social Security application, physicians and the applicant's certification.
SF 3112B: Supervisor's Statement
Sections A to F: applicant identification, performance, attendance and leave hours, conduct, accommodation and reassignment, and the supervisor's certification.
SF 3112C: Physician's Statement
Section A for the applicant's details and consent, and Section B for the physician, with five Medical Documentation Requirements on the reverse.
SF 3112D: Agency Certification of Reassignment and Accommodation Efforts
Items 1 to 7: whether reasonable accommodation was made, the result of reassignment efforts, any temporary position, and the official's certification.
SF 3112E: Disability Retirement Application Checklist
Items 1 to 14: service, duty status, Veterans' Affairs compensation, Social Security application, the attached documents, performance appraisals and the agency certification.
How to complete SF 3112
- 1
Read the cover page and pamphlet
The cover page says to ask your agency for the pamphlet Information About Disability Retirement if you did not receive it.
- 2
Complete and sign SF 3112A
Describe each disease or injury in item 4; the form says only those discussed in the application are considered. List the physicians you plan to ask for SF 3112C in item 12, then sign item 13.
- 3
Give SF 3112B to your supervisor
The form says a copy of the completed SF 3112A goes with the Supervisor's Statement given to the supervisor.
- 4
Give SF 3112C to each physician
Complete and sign Section A and attach a copy of your current position description. The form asks the physician to complete the statement within 2 weeks and send it in a sealed envelope marked Medical Disability, Privileged, Private.
- 5
Attach the Social Security receipt (FERS, CSRS offset)
For FERS or CSRS offset applicants, the form says the Social Security application receipt or award notice should be attached, and that the application cannot be completely processed without it.
- 6
Return the forms
If not separated, return everything to your agency's personnel office, which assembles the package and sends it to OPM. If separated more than 31 days, the cover page says to assemble the package and send it to OPM yourself.
Why fill Form SF3112 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the GSA, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes, time and privacy
Where it goes
Through the agency personnel office, or, for applicants separated more than 31 days, to: U.S. Office of Personnel Management, Retirement Operations Center, P.O. Box 45, Boyers, PA 16017-0045.
Time limit printed on the form
The cover page says OPM must receive the application not more than one year after the date the applicant separated, and not to delay submitting SF 3112A if all the information cannot be obtained.
Current medical evidence
The cover page asks that the information submitted contain a diagnosis, prognosis and treatment plan dated no more than 60 days before the date the application is filed.
Supervisor and agency copies
SF 3112B and SF 3112D say to return the original to the employee or the personnel office, give a copy to the employee, and not send the form directly to OPM unless OPM asks.
Time to complete
OPM estimates an average of 30 minutes per response for SF 3112A and 60 minutes for SF 3112C. OMB No. 3206-0228.
Privacy
Collection is authorized by Chapters 83 and 84 of title 5, U.S. Code. The form says furnishing the data is voluntary, but failure to do so will delay or prevent action on the retirement application.
Related forms
Who completes SF 3112?
Each form in the package names who completes it.
Official sources and the blank
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Questions about Form SF3112
Who issues SF 3112?
Each form in the package is printed as a U.S. Office of Personnel Management form, Revised May 2011, OMB No. 3206-0228. GSA hosts a copy in its forms library.
Which forms are in the SF 3112 package?
SF 3112A Applicant's Statement of Disability, SF 3112B Supervisor's Statement, SF 3112C Physician's Statement, SF 3112D Agency Certification of Reassignment and Accommodation Efforts, and SF 3112E Disability Retirement Application Checklist.
Where do the completed forms go?
The cover page says applicants not separated return them to the agency personnel office, which sends the package to OPM. Applicants separated for more than 31 days send it to OPM's Retirement Operations Center in Boyers, PA.
Is there a time limit?
The cover page says OPM must receive the application not more than one year after the date the applicant separated from the position.
Who pays for the physician's statement?
The instructions on SF 3112C say the applicant is responsible for any costs incurred in connection with providing the documentation.
What does the form say about Social Security for FERS applicants?
It says FERS and CSRS offset applicants document a Social Security disability application, and that if Social Security awards benefits, OPM payments are reduced from the date the award started, which may cause an overpayment.
Can the supervisor send SF 3112B straight to OPM?
The form asks the supervisor not to send it directly to OPM unless OPM specifically requested it, and to return the original to the employee or the personnel office with a copy to the employee.