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DISABILITY CLAIM REQUEST FOR EXTENSIONDisability Claim (request for extension) Instructions If the employee is not currently receiving short term or long term benefits, please use the forms under

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What is disability claim request for?

Disability claim request is for individuals who are unable to work due to a disability and are seeking financial assistance.

Who is required to file disability claim request for?

Individuals who are unable to work due to a disability and are seeking financial assistance are required to file disability claim request.

How to fill out disability claim request for?

Disability claim request can be filled out by providing personal information, medical history, and details about the disability.

What is the purpose of disability claim request for?

The purpose of disability claim request is to request financial assistance for individuals who are unable to work due to a disability.

What information must be reported on disability claim request for?

Information such as personal details, medical history, and details about the disability must be reported on disability claim request.

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