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VILLAGE OF BUFFALO GROVE Fifty Ralph Blvd. Buffalo Grove, IL 60089-2196 Phone 847-459-2500 Fax 847-459-7906 Date Name Address City, State, Zip Code Dear : I am in receipt of your request dated to

How to fill out pseba form

How to fill out PSEBA:

1. Begin by obtaining the necessary forms from the relevant authority or agency.
2. Fill out your personal information accurately and completely, including your full name, address, contact information, and relevant identification numbers.
3. Provide details about your employment, such as your job title, employer's name and address, and the dates of your employment.
4. Indicate the incident or injury that occurred, explaining the circumstances and the impact it has had on your physical or mental health.
5. Attach any supporting documentation, such as medical records, police reports, or witness statements, that strengthen your case.
6. Review your completed forms carefully for any errors, and make sure all required sections, signatures, and attachments are included.
7. Submit the filled out forms and any accompanying documents to the designated authority within the specified timeframe.

Who needs PSEBA:

1. Active duty police officers and firefighters who are injured or killed in the line of duty.
2. Retired police officers and firefighters who suffer a catastrophic injury or are killed as a result of their previous service.
3. Spouses and dependent children of police officers and firefighters who die in the line of duty, provided they meet the eligibility criteria.

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What is pseba?

PSEBA stands for Public Safety Employee Benefits Act. It is an Illinois state law that provides certain benefits to public safety employees who suffer catastrophic injuries or are killed in the line of duty.

Who is required to file pseba?

Public safety employees, such as police officers, firefighters, and paramedics, who meet the eligibility criteria are required to file for PSEBA benefits.

How to fill out pseba?

To fill out PSEBA, eligible public safety employees need to submit the required application form provided by their employer or the relevant authority. The form typically requires personal and employment information.

What is the purpose of pseba?

The purpose of PSEBA is to provide additional benefits to public safety employees and their families in case of catastrophic injuries or death resulting from their duties.

What information must be reported on pseba?

The PSEBA application typically requires information such as the name and contact details of the applicant, details of the injury or death, and supporting documentation.