Disability Forms

Employer Statement for STD and LTD Income Benefits

This form must be completed by your employer when you apply for STD or LTD income benefits.

Member Report for STD and LTD Income Benefits

This form must be completed to apply for STD or LTD income benefits.

Physician Report for Disability Benefits

This form must be completed by your physician when applying for disability benefits.

Physician/Psychologist Report for Disability Benefits

This form must be completed by your physician or psychologist when applying for mental health disability benefits.

Vocational Assessment Form Disability

This form must be completed to apply for LTD income benefits.

Disability Direct Deposit Authorization

This form must be completed to authorize electronic fund transfer for disability benefits.

1475 Kendale Blvd., P.O. Box 2560, East Lansing, MI 48826