SF 3112 – Applicant’s Statement of Disability (Fillable PDF)

The SF 3112 is the official Applicant’s Statement of Disability used by federal employees who are applying for disability retirement under the Civil Service Retirement System (CSRS) or the Federal Employees Retirement System (FERS). This fillable PDF can be completed directly in your browser with the Formize PDF Filler, eliminating the need for printed copies or third‑party editors.

What Is SF 3112?

SF 3112 collects detailed information about your medical condition, how it affects your ability to perform job duties, and any accommodations you have requested. A completed SF 3112 must be submitted with the supervisor’s statement (SF 3112B) to start the disability retirement process.

How to Complete the SF 3112 Form Online

Follow these simple steps to fill out the form using Formize’s built‑in PDF filler:

• Click the “Fill out this form” button on this page.
• Wait a few seconds while the Formize PDF Filler app loads the fillable version of SF 3112.
• Enter your personal information, describe your disability, and answer all required questions.
• Use the signature field to sign electronically, then click Save or Download to keep a copy.

Common Mistakes to Avoid

• Leaving fields blank: Every required field is marked with an asterisk. Incomplete sections can delay processing.
• Incorrect dates: Use the mm/dd/yyyy format for all dates.
• Not attaching supporting documents: Attach physician statements and any other evidence before submitting.
• Using an outdated version: The current revision is May 2011; the linked PDF reflects this version.

Download and Save Your Completed Form

After you finish, you can download the completed PDF, print it for your records, or email it directly to your agency’s HR office. The fillable version ensures that the formatting stays intact, making it easier for reviewers to read.

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