Employers' Pensions and Benefits Administration Manual (EPBAM)
   

 

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Sample Employer Letter Requesting an Involuntary
Disability Retirement for an Employee


Employer Letterhead

<<Date>>


Director
Division of Pensions and Benefits
PO Box 295
Trenton, NJ 08625-0295

 

Dear <<Name of Director>>:

(Use for PERS or TPAF members only [1]) <<Name of employee>> is employed by <<name of location>> in the position of <<title>> and is an active member of the <<TPAF or PERS, choose one>> with at least ten years of credited service.

OR

(Use for PFRS and SPRS members only [1]) <<Name of employee>> is employed by <<name of location>> in the position of <<title>> and is an active member of the <<PFRS or SPRS, choose one>> with at least four years of credited service.

We believe that <<name of the employee>> is totally and permanently disabled and can no longer perform his/her assigned duties. Since we are unable to provide an alternative <<PFRS-, TPAF-, PERS-, or SPRS-, choose one>> covered position with duties capable of being performed by the employee, <<name of the employee>> should be approved for a disability retirement benefit from the <<PFRS, TPAF, PERS, or SPRS, choose one>>.

 

Sincerely,

<<Signature and printed name of PFRS, TPAF, PERS, or SPRS Certifying Officer>>
<<Title>>

 

[1] PERS and TPAF members must have ten or more years of New Jersey service credit in order to be eligible for a PERS/TPAF disability retirement, in addition to meeting the other requirements for this type of retirement.

PFRS and SPRS members must have four or more years of New Jersey service credit in order to be eligible for a PFRS or SPRS disability retirement, in addition to meeting the other requirements for this type of retirement.

 

 

 

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Last Updated: October 27, 2005